Federico Yandian, Department of Nephrology, Médica Uruguaya, Montevideo, Uruguay; Editorial Board RED-IRA, Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH);
Martina Wild, Department of Nephrology, Médica Uruguaya, Montevideo, Uruguay; Nephrology Center, Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay
Lucía Facal, Department of Nephrology, Médica Uruguaya, Montevideo, Uruguay; Nephrology Center, Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay
Introduction: Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, may present extraintestinal manifestations in 5–50% of patients and may be associated with renal and urinary involvement through extraintestinal manifestations, metabolic complications, or drug-related nephrotoxicity. Material and methods: Narrative review focused on renal manifestations associated with inflammatory bowel disease, including tubulointerstitial nephritis, glomerulopathies, nephrolithiasis, and treatment-related renal toxicity. Results: Renal and urinary involvement has been reported in 4-23% of cases, most commonly as urolithiasis, fistulas, or ureteral obstruction. Parenchymal kidney disease is less frequent and includes IgA nephropathy, tubulointerstitial nephritis, acute tubular necrosis, immune complex-mediated proliferative glomerulonephritis, arteriosclerosis without specific changes, and other glomerular diseases. Kidney biopsy may be required to distinguish drug-induced nephrotoxicity from active extraintestinal renal involvement or concomitant glomerulopathy. Conclusions: Diagnostic evaluation of renal involvement in inflammatory bowel disease should integrate clinical assessment, laboratory testing, and, when indicated, kidney biopsy. An interdisciplinary approach involving nephrology and gastroenterology is essential to differentiate between drug-induced nephrotoxicity, active extraintestinal manifestations, and concomitant glomerular disease, thereby optimizing renal and overall outcomes. This approach allows continuation of therapies with proven efficacy in controlling chronic intestinal inflammation while minimizing exposure to nephrotoxic agents that may compromise patient survival and quality of life.
Keywords: Inflammatory bowel disease. Extraintestinal manifestations. Kidney disease. Tubulointerstitial nephritis. Glomerulopathies. Drug-induced nephrotoxicity.
