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Tubulointerstitial nephritis as an extraintestinal manifestation of Crohn's disease

Nature Clinical Practice Nephrology volume 4, pages 693–697 (2008)Cite this article

Abstract

Background A 12-year-old boy presented to hospital with a 6-month history of crampy pre-defecation abdominal pain, non-bloody diarrhea, anorexia and weight loss. Investigations revealed hypochromic microcytic anemia, a low serum iron level, a low serum ferritin level and an elevated serum creatinine level. Histopathological examination of tissue specimens obtained at esophagogastroduodenoscopy and colonoscopy revealed features of Crohn's disease, and a renal biopsy demonstrated tubulointerstitial nephritis. A second case of tubulointerstitial nephritis in a patient with Crohn's disease, is also presented.

Investigations Physical examination, laboratory tests including full blood count, electrolytes, renal function, serum albumin, urinalysis and 24 h urinary protein, esophagogastroduodenoscopy, colonoscopy, abdominal ultrasonography, dimercaptosuccinic acid scan, renal diethylene triamine pentaacetic acid clearance study and renal biopsy.

Diagnosis Tubulointerstitial nephritis secondary to Crohn's disease.

Management Prednisone therapy (60 mg/day) for 1 month followed by a tapering schedule over 3 months.

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Figure 1: Renal biopsy findings from two patients with tubulointerstitial nephritis secondary to Crohn's disease.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. M Zachos is a Clinician Specialist in the Division of Gastroenterology, AM Waters is a Nephrology Fellow at the Hospital for Sick Children, Hepatology and Nutrition at the Hospital for Sick Children, and an Assistant Professor of Paediatrics at the University of Toronto, AM Herzenberg is a Consultant Nephropathologist at the University Health Network and the Hospital for Sick Children and an Assistant Professor of Pathology at the University of Toronto, E Harvey is an Associate Professor of Paediatrics at the University of Toronto and a Paediatric Nephrologist at the Hospital for Sick Children, and ND Rosenblum is a Professor of Paediatrics and Canada Research Chair in Developmental Nephrology at the University of Toronto and a Paediatric Nephrologist and Senior Scientist at the Hospital for Sick Children, Toronto, ON, Canada.,

    Aoife M Waters, Mary Zachos, Andrew M Herzenberg, Elizabeth Harvey & Norman D Rosenblum

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  1. Aoife M Waters
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Correspondence to Aoife M Waters.

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Waters, A., Zachos, M., Herzenberg, A. et al. Tubulointerstitial nephritis as an extraintestinal manifestation of Crohn's disease. Nat Rev Nephrol 4, 693–697 (2008). https://doi.org/10.1038/ncpneph0955

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