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Tang J, Wang L, Zhou W, Mao Y, Zhang C, Shen J, Yin M, Yin L. IgA nephropathy and IgA vasculitis in a pediatric Crohn's disease patient with early IgA deposition in vascular walls of intestines. CEN Case Rep 2025; 14:335-344. [PMID: 40011366 DOI: 10.1007/s13730-025-00970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 01/07/2025] [Indexed: 02/28/2025] Open
Abstract
Patients with inflammatory bowel disease may present with extraintestinal manifestations. Crohn's disease complicated with IgA nephropathy or IgA vasculitis is relatively rare. In this case, an 11-year-old girl was diagnosed with Crohn's disease and infliximab was administered. 1 year after treatment, she presented with asymptomatic but persistent microscopic hematuria. The child was diagnosed with IgA vasculitis and IgA nephropathy at the fourth year of follow-up. To explore the association between Crohn's disease and IgA associated diseases, immunostaining for IgA and GdIgA1 deposition was retrospectively conducted in intestinal biopsy tissues obtained at the time of initiation and relapse of Crohn's disease. GdIgA1 deposition in intestinal tissues was found not only at the time of relapse of Crohn's disease, but also at the beginning of Crohn's disease when patient had neither exposure to any drug nor any symptom of IgA vasculitis or IgA nephropathy. The early appearance of GdIgA1 deposition indicated that Crohn's disease played a greater role in its formation than infliximab induction and the child might be prone to IgA associated diseases. Patients with Crohn's disease, especially those who receive tumor necrosis factor-alpha inhibitors are recommended to receive regular kidney examinations.
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Affiliation(s)
- Junqian Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Lan Wang
- Department of Gastroenterology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Wei Zhou
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Youying Mao
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Chenxing Zhang
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Minzhi Yin
- Department of Pathology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China.
| | - Lei Yin
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China.
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de Sire R, La Mantia A, Bonacci L, Testa A, Guarino AD, Rispo A, Nardone OM, Castiglione F. Inflammatory Bowel Diseases and Nephropathies: Exploring the Gut-Kidney Axis. Life (Basel) 2024; 14:1541. [PMID: 39768250 PMCID: PMC11678131 DOI: 10.3390/life14121541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 11/14/2024] [Accepted: 11/19/2024] [Indexed: 01/11/2025] Open
Abstract
Inflammatory bowel disease (IBD) can extend beyond the gastrointestinal tract, affecting extraintestinal organs and significantly increasing morbidity and mortality. Despite early studies revealing kidney involvement in nearly a quarter of patients with IBD, renal manifestations have been notably overlooked. Among these manifestations, nephrolithiasis, obstructive uropathy, and fistula formation between the bowel and urinary tract are the most reported occurrences. Additionally, renal parenchymal involvement in IBD, including glomerulonephritis (GN), tubulointerstitial nephritis, and amyloidosis, has been documented. GN is particularly noteworthy, as a significant proportion of patients progress to end-stage kidney disease (ESKD). Although GN has long been recognized as a potential extraintestinal manifestation (EIM) of IBD, it has often been dismissed as an anecdotal association. Recently, several studies highlighted the clinical correlation between GN and IBD, suggesting a pathogenic interplay involving gut inflammation, dysbiosis, and intrinsic glomerular processes. Thus, our objective is to elucidate the basis of IBD-related nephropathies, with a specific focus on IgA nephropathy (IgAN) and the gut-kidney axis.
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Affiliation(s)
- Roberto de Sire
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
- Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Alessia La Mantia
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
| | - Livio Bonacci
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
| | - Anna Testa
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
| | - Alessia Dalila Guarino
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
| | - Antonio Rispo
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
| | - Olga Maria Nardone
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
| | - Fabiana Castiglione
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (A.L.M.); (L.B.); (A.T.); (A.D.G.); (A.R.); (O.M.N.); (F.C.)
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Singh A, Khanna T, Mahendru D, Kahlon J, Kumar V, Sohal A, Yang J. Insights into renal and urological complications of inflammatory bowel disease. World J Nephrol 2024; 13:96574. [PMID: 39351187 PMCID: PMC11439091 DOI: 10.5527/wjn.v13.i3.96574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/01/2024] [Accepted: 07/15/2024] [Indexed: 09/19/2024] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract, which follows a relapsing and remitting course. Apart from affecting the gastrointestinal tract, IBD also has extra-intestinal manifestations (EIMs). While the etiology of extraintestinal manifestation remains unclear, it is theorized to be based on immunological responses influenced by genetic factors. Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn's disease. The renal manifestations in IBD patients encompass a range of conditions including nephrolithiasis, amyloidosis, tubulointerstitial nephritis, glomerulonephritis (GN), obstructive pathologies, and chronic kidney disease (CKD). The incidence of CKD in IBD patients varies from 5%-15%. The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury, or from complications like recurrent stones, amyloidosis, or GN. Additionally, nephrotoxic medications used in treating IBD, such as TNF-α inhibitors, calcineurin inhibitors, and aminosalicylates, can exacerbate the decline in renal function. Currently, there is a lack of consensus regarding these patients' screening and renal function monitoring. This review aims to assess the existing literature on the different renal complications among individuals with IBD, shedding light on their pathophysiology and management.
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Affiliation(s)
- Anmol Singh
- Department of Medicine, Tristar Centennial Medical Center, Nashville, TN 37203, United States
| | - Tejasvini Khanna
- Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Diksha Mahendru
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Jasraj Kahlon
- Department of Internal Medicine, Abrazo Medical Center, Phoenix, AZ 85015, United States
| | - Vikash Kumar
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, United States
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA 98105, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States
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Yandian F, Caravaca-Fontán F, Herrera Hernandez LP, Soler MJ, Sethi S, Fervenza FC. Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes. Kidney Int Rep 2024; 9:383-394. [PMID: 38344742 PMCID: PMC10851004 DOI: 10.1016/j.ekir.2023.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 09/19/2024] Open
Abstract
INTRODUCTION Kidney disease is a well-known extraintestinal manifestation (EIM) associated with inflammatory bowel disease (IBD), with a variety of underlying etiologies. However, little is known about the overall outcomes and predictors. METHODS This is a retrospective, observational cohort study. Patients with IBD in whom a native kidney biopsy was performed at Mayo Clinic (Rochester, MN) between 1994 and 2022, were included. Demographic, clinical, and histologic characteristics of prognostic interest were collected. The main outcomes were kidney failure, disease remission, kidney function changes at last follow-up, and death. RESULTS From a total cohort of 318 patients, we selected a study group of 111 patients followed-up with at our institution (45 ulcerative colitis [UC] and 66 Crohn's disease [CD]), with a mean age of 48 ± 17 years (40% females). IgA nephropathy (IgAN), chronic interstitial nephritis (CIN), and acute interstitial nephritis (AIN) were the most common diagnoses (22%, 19%, 13%, respectively). Median estimated glomerular filtration rate (eGFR) at presentation was 30 ml/min per 1.73 m2 (interquartile range [IQR]: 17-54) and urinary protein-to-creatinine ratio [UPCR] 0.8 g/g (0.3-3.4), without differences between IBD types. During a median follow-up of 59 months (12-109), 29 patients (26%) reached kidney failure. By multivariable analysis, the main predictors of kidney failure were age (hazard ratio [HR]: 1.04; P = 0.002), baseline eGFR (HR: 0.94; P = 0.003) and histologic chronicity score (HR: 4.01; P < 0.001). Therapeutic management varied according to underlying etiology. Global survival (kidney failure + death) was significantly better in patients who achieved complete or partial remission, or stabilization or improvement of kidney function. CONCLUSION One-fourth of patients with IBD with kidney disease may reach kidney failure, and the main determinants of this outcome is age, baseline eGFR, and degree of chronicity in kidney biopsy.
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Affiliation(s)
- Federico Yandian
- Department of Nephrology, Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay
| | - Fernando Caravaca-Fontán
- Department of Nephrology, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | | | - Maria José Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Abdulrhman A, Alsweed A, Alotaibi MR, Aldakhil AY, Alahmadi SF, Albishri SM, Alhmed NI. Urolithiasis in patients with inflammatory bowel disease: A systematic review and meta-analysis of 13,339,065 individuals. Medicine (Baltimore) 2023; 102:e33938. [PMID: 37327280 PMCID: PMC10270553 DOI: 10.1097/md.0000000000033938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/16/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND This study aimed to summarize the current literature regarding the prevalence of renal stones in patients with inflammatory bowel disease (IBD). Moreover, we aimed to evaluate the risk factors of urolithiasis in patients with IBD and the difference between patients with IBD and healthy controls in terms of urinary profile. METHODS On February 23, 2022, a computerized search was conducted on PubMed, OVID via MEDLINE, Web of Science, and Scopus using relevant keywords. Three independent reviewers performed 2-stage screening and data extraction. The National Institutes of Health tools were employed for quality assessment. Review Manager 5.4 software was used to calculate the mean difference (MD) between IBD patients and non-IBD in terms of urine profile using the Inverse-variance model and to estimate the odds ratio of reported risk factors for renal stones with the Generic Inverse-Variance model. RESULTS Thirty-two articles (n = 13,339,065 patients) were included. The overall prevalence of renal stones in patients with IBD was 6.3%, 95% Confidence interval (4.8%-8.3%). The prevalence of urolithiasis was more common in Chron's disease vs Ulcerative colitis (7.9% vs 5.6%) and in old studies (1964-2009) than in more recent studies (2010-2022) (7.3% vs 5.2%), respectively. Compared to non-IBD patients, patients with IBD were associated with significantly lower urine volume (MD = -518.84 mL/day, P < .00001), calcium 24-hour urine (MD = -28.46 mg/day, P < .0001), citrate 24-hour urine (MD = -144.35 mg/day, P < .00001), sodium 24-hour urine (MD = -23.72 mg/day, P = .04), and magnesium 24-hour urine (MD = -33.25 mg/day, P < .00001). CONCLUSION The overall prevalence of renal stones in patients with IBD was comparable to the general population. Patients with Chron's disease were associated with a higher prevalence of urolithiasis compared to Ulcerative colitis. Drugs that induce renal calculi should be stopped in high-risk patients.
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Affiliation(s)
- Aldukhayel Abdulrhman
- Department of Family and Community Medicine, Qassim University, College of Medicine, Buraidah, Saudi Arabia
| | - Adil Alsweed
- PHC Physician, Ministry of Health, Qassim, Saudi Arabia
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Zhang Q, Li H, Huang WF. When Crohn's disease meets IgA nephropathy: What do you think? Am J Med Sci 2023; 365:e78-e79. [PMID: 36574819 DOI: 10.1016/j.amjms.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/16/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Qi Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Hua Li
- Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wei-Feng Huang
- Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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Kumar S, Pollok R, Goldsmith D. Renal and Urological Disorders Associated With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022:6658535. [PMID: 35942657 PMCID: PMC10393213 DOI: 10.1093/ibd/izac140] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 12/15/2022]
Abstract
Renal and urinary tract complications related to inflammatory bowel disease (IBD) have been relatively understudied in the literature compared with other extraintestinal manifestations. Presentation of these renal manifestations can be subtle, and their detection is complicated by a lack of clarity regarding the optimal screening and routine monitoring of renal function in IBD patients. Urolithiasis is the most common manifestation. Penetrating Crohn's disease involving the genitourinary system as an extraintestinal complication is rare but associated with considerable morbidity. Some biologic agents used to treat IBD have been implicated in progressive renal impairment, although differentiating between drug-related side effects and deteriorating kidney function due to extraintestinal manifestations can be challenging. The most common findings on renal biopsy of IBD patients with renal injury are tubulointerstitial nephritis and IgA nephropathy, the former also being associated with drug-induced nephrotoxicity related to IBD medication. Amyloidosis, albeit rare, must be diagnosed early to reduce the chance of progression to renal failure. In this review, we evaluate the key literature relating to renal and urological involvement in IBD and emphasize the high index of suspicion required for the prompt diagnosis and treatment of these manifestations and complications, considering the potential severity and implications of acute or chronic loss of renal function. We also provide suggestions for future research priorities.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - David Goldsmith
- Renal and Transplantation Department, Guys and St Thomas' Hospitals NHS Foundation Trust, Great Maze Pond, London, UK
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Vedolizumab-Induced Acute Interstitial Nephritis in Ulcerative Colitis. ACG Case Rep J 2022; 9:e00788. [PMID: 35765681 PMCID: PMC9232362 DOI: 10.14309/crj.0000000000000788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/02/2022] [Indexed: 12/25/2022] Open
Abstract
Vedolizumab is used in the treatment of inflammatory bowel disease and is generally well tolerated. We report a 20-year-old man who presented with right flank pain on a background of ulcerative colitis. He was on vedolizumab with his last dose 1 week before the onset of symptoms. Kidney function tests revealed a serum creatinine of 171 μmoL/L and a C-reactive protein of 74 mg/L. Kidney biopsy demonstrated focal acute interstitial nephritis. He was prescribed oral prednisolone and achieved complete recovery of renal function within 3 weeks. At the follow-up after 4 months, his renal function remains normal.
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Kim YN, Jung Y. [Renal and Urinary Manifestations of Inflammatory Bowel Disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:260-268. [PMID: 31132832 DOI: 10.4166/kjg.2019.73.5.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/03/2022]
Abstract
The incidence of inflammatory bowel disease (IBD) is increasing rapidly and extra-intestinal manifestations in IBD are also increasing. The prevalence of renal and urinary involvement in IBD ranges from 4-23%. Nephrolithiasis is the most common urinary complication in IBD patients. Parenchymal renal disease is rare but has been well documented and presents most commonly as glomerulonephritis or tubulointerstitial nephritis. The overall morbidity of IBD-related renal manifestations is significant. Therefore, a high index of clinical suspicion and optimal monitoring of the renal function are needed for the early diagnosis and prevention of IBD-related renal manifestations and complications.
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Affiliation(s)
- Ye Na Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeonsoon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Ambruzs JM, Walker PD, Larsen CP. The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease. Clin J Am Soc Nephrol 2014; 9:265-70. [PMID: 24262508 PMCID: PMC3913236 DOI: 10.2215/cjn.04660513] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney disease as a complication of inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), has been the subject of case reports. However, no cases series examining IBD and kidney disease has been published to date. This study aimed to evaluate a large series of kidney biopsy specimens from patients with IBD to better define the spectrum and relative frequencies of IBD-associated kidney pathology. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A retrospective review of native kidney biopsy specimens obtained from March 2001 to June 2012 identified 83 patients with IBD. Standard processing of all biopsy specimens included light microscopy, immunofluorescence, and electron microscopy. RESULTS There were 45 cases of CD and 38 cases of UC represented. The most common indication for kidney biopsy was acute or chronic kidney failure (63% [52 of 83]) and nephrotic-range proteinuria (16% [13 of 83]). IgA nephropathy was the most common diagnosis (24% [20 of 83]), followed by interstitial nephritis (19% [16 of 83]), arterionephrosclerosis (12% [10 of 83]), acute tubular injury (8% [7 of 83]), proliferative GN (7% [6 of 83]), and minimal-change disease (5% [4 of 83]). When compared, the frequency of IgA nephropathy in IBD was significantly higher than in all other native renal biopsy specimens from the same time period (24% [20 of 83] versus 8% [2734 of 33,630]; P<0.001). Of the 16 cases of interstitial nephritis, 9 (56%) had current or recent past exposure to aminosalicylates, including all cases of granulomatous interstitial nephritis. CONCLUSIONS IBD is associated with a spectrum of kidney diseases most commonly affecting the glomerular and tubulointerstitial compartments. IgA nephropathy is the most frequent kidney biopsy diagnosis in IBD and has a significantly higher diagnostic prevalence compared with all non-IBD kidney biopsy specimens. This may reflect a common pathogenic mechanism. Although many cases of tubulointerstitial nephritis are related to aminosalicylate exposure, the possibility of a direct relationship with IBD cannot be ruled out.
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Affiliation(s)
| | - Patrick D. Walker
- Nephropath, Little Rock, Arkansas; and
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Christopher P. Larsen
- Nephropath, Little Rock, Arkansas; and
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Xia CM, Gulick MA, Yu SJ, Grider JR, Murthy KS, Kuemmerle JF, Akbarali HI, Qiao LY. Up-regulation of brain-derived neurotrophic factor in primary afferent pathway regulates colon-to-bladder cross-sensitization in rat. J Neuroinflammation 2012; 9:30. [PMID: 22335898 PMCID: PMC3298724 DOI: 10.1186/1742-2094-9-30] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 02/15/2012] [Indexed: 12/30/2022] Open
Abstract
Background In humans, inflammation of either the urinary bladder or the distal colon often results in sensory cross-sensitization between these organs. Limited information is known about the mechanisms underlying this clinical syndrome. Studies with animal models have demonstrated that activation of primary afferent pathways may have a role in mediating viscero-visceral cross-organ sensitization. Methods Colonic inflammation was induced by a single dose of tri-nitrobenzene sulfonic acid (TNBS) instilled intracolonically. The histology of the colon and the urinary bladder was examined by hematoxylin and eosin (H&E) stain. The protein expression of transient receptor potential (TRP) ion channel of the vanilloid type 1 (TRPV1) and brain-derived neurotrophic factor (BDNF) were examined by immunohistochemistry and/or western blot. The inter-micturition intervals and the quantity of urine voided were obtained from analysis of cystometrograms. Results At 3 days post TNBS treatment, the protein level of TRPV1 was increased by 2-fold (p < 0.05) in the inflamed distal colon when examined with western blot. TRPV1 was mainly expressed in the axonal terminals in submucosal area of the distal colon, and was co-localized with the neural marker PGP9.5. In sensory neurons in the dorsal root ganglia (DRG), BDNF expression was augmented by colonic inflammation examined in the L1 DRG, and was expressed in TRPV1 positive neurons. The elevated level of BDNF in L1 DRG by colonic inflammation was blunted by prolonged pre-treatment of the animals with the neurotoxin resiniferatoxin (RTX). Colonic inflammation did not alter either the morphology of the urinary bladder or the expression level of TRPV1 in this viscus. However, colonic inflammation decreased the inter-micturition intervals and decreased the quantities of urine voided. The increased bladder activity by colonic inflammation was attenuated by prolonged intraluminal treatment with RTX or treatment with intrathecal BDNF neutralizing antibody. Conclusion Acute colonic inflammation increases bladder activity without affecting bladder morphology. Primary afferent-mediated BDNF up-regulation in the sensory neurons regulates, at least in part, the bladder activity during colonic inflammation.
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Affiliation(s)
- Chun-Mei Xia
- Department of Physiology, Virginia Commonwealth University School of Medicine, 1220 East Broad Street, PO Box 0551, MMRB 5038, VA 23219 Richmond, Virginia, USA
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Mazziotti S, Ascenti G, Scribano E, Gaeta M, Pandolfo A, Bombaci F, Donato R, Fries W, Blandino A. Guide to magnetic resonance in Crohn's disease: from common findings to the more rare complicances. Inflamm Bowel Dis 2011; 17:1209-1222. [PMID: 21484963 DOI: 10.1002/ibd.21548] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 09/27/2010] [Indexed: 12/13/2022]
Abstract
Considering that multiple imaging examinations are often necessary for monitoring Crohn's disease (CD) activity and severity in order to guide and monitor appropriate treatment, the ideal imaging test would be reproducible, well tolerated by patients, and free of ionizing radiation. For these reasons recent studies have highlighted the role of a magnetic resonance imaging (MRI) technique optimized for small bowel imaging in the evaluation of small bowel disorders. In this regard there are two main methodological approaches represented by MR enterography, following administration of an oral contrast medium, and MR enteroclysis, following administration of contrast medium through a nasojejuneal tube. MRI may be used to demonstrate the pathologic findings and complications of CD. In particular, MR has excellent sensitivity and specificity, ranging from 88%-98% and 78%-100%, respectively, for the detection of active inflammation, wall thickening, ulcerations, increased wall enhancement, increased vascularity, perienteric inflammation, and reactive adenopathy. MR also allows more accurate identification of associated complications including penetrating and fibrostenotic disease as well as the more rare extraintestinal manifestations that are usually associated with severe and longstanding intestinal inflammation, the latter often guiding the therapeutic approach. In the progression of CD some rare complications can occur that, to our knowledge, were only briefly or never mentioned in the radiological literature regarding MR enterography or enteroclysis and in which the application of these techniques play a key role.
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Affiliation(s)
- Silvio Mazziotti
- Department of Radiological Sciences, University of Messina, Policlinico "G. Martino," Messina, Italy.
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Abstract
Noncalculous ureteral obstructions in Crohn's disease are often asymptomatic and unidentified. Occurring in about 3% of patients, they occur on the right side in more than 70% of cases, because of frequently associated ileocecal disease. If they are associated with inflammation or fibrosis of retroperitoneal periureteral fat nephrectomy may become necessary. Conservative treatment should be considered first, with urine drainage (ureteral stent, or percutaneous nephrostomy), diet, and corticotherapy. However bowel resection is often necessary during follow up. If this fails to cure the ureteral obstruction, ureterolysis should be performed. We report the case of a 32 year old woman with noncalculous ureteral obstruction revealing Crohn's disease.
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Affiliation(s)
- Sébastien Gaujoux
- Service de chirurgie viscérale et digestive, Centre Hospitalier de Longjumeau, 159 rue du président François Mitterrand, 91164 Longjumeau Cedex
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Ueno Y, Tanaka S, Kanao H, Yoshioka K, Hatakeyama T, Shimamoto M, Miyanaka Y, Hiyama T, Ito M, Kitadai Y, Yoshihara M, Chayama K. A case of Crohn's disease with hydronephrosis caused by ureteropelvic junction obstruction. Eur J Gastroenterol Hepatol 2006; 18:1015-8. [PMID: 16894317 DOI: 10.1097/01.meg.0000224472.59051.7e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ureteral obstruction is a rare extraintestinal manifestation of Crohn's disease (CD). We report the case of a 20-year-old man who presented with fever, diarrhoea, and lower abdominal pain. Diagnostic studies confirmed CD and revealed an abdominal mass obstructing the right ureter and hydronephrosis. Ureteropelvic junction (UPJ) obstruction was diagnosed. Despite an elemental diet and mesalazine therapy, the hydronephrosis persisted, and the patient eventually required surgery. Successful laparoscopic pyeloplasty was performed. This is the first report of CD associated with UPJ obstruction. Ureteral obstruction as a complication of CD is discussed.
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Affiliation(s)
- Yoshitaka Ueno
- Department of Endoscopy, Hiroshima University Hospital, Japan
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15
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Abstract
Inflammatory bowel diseases are associated with extraintestinal manifestations involving almost every organ system in the body. They occur in approximately 20% to 40% of patients with inflammatory bowel diseases. Immune-related and genetic mechanisms play an important role in the pathogenesis of these complications. Peripheral arthritis, erythema nodosum, and episcleritis respond to the treatment of the underlying intestinal inflammation, whereas axial arthropathy, pyoderma gangrenosum, and uveitis do not. Immunomodulator therapy, particularly with biologic agents has been shown to be effective in treating some of the extraintestinal manifestations. Early recognition and treatment are crucial in preventing major morbidity.
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Affiliation(s)
- Sripathi R Kethu
- Department of Medicine, Division of Gastroenterology, Brown Medical School, Providence, RI 02912, USA.
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16
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Forshaw MJ, Guirguis O, Hennigan TW. IgA nephropathy in association with Crohn's disease. Int J Colorectal Dis 2005; 20:463-5. [PMID: 15668785 DOI: 10.1007/s00384-004-0696-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND Urological complications of inflammatory bowel disease are seen in up to 25% of patients, but renal parenchymal disease is rarely reported. CASE REPORT The authors describe a case of a 29-year-old man with clinical and radiological features of ileocaecal Crohn's disease. He had previously been investigated for painless macroscopic haematuria and a renal biopsy had revealed IgA nephropathy. Despite medical treatment, regular exacerbations of Crohn's disease were associated with deterioration in renal function and the development of haematuria. The patient eventually underwent surgical resection of the terminal ileum and caecum. His renal disease has remained quiescent for the last 5 years following resection.
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Affiliation(s)
- M J Forshaw
- Department of Surgery, Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8ND, UK.
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17
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Leong WS, Sells H, Moretti KL. Anuric, obstructive uropathy in the absence of obvious radiological evidence of obstruction. ANZ J Surg 2004; 74:611-3. [PMID: 15230807 DOI: 10.1111/j.1445-2197.2004.03001.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wing-Seng Leong
- Urology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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18
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Abstract
The primary goals of the clinician in the treatment of fistulizing Crohn's disease (CD) include (1) defining the anatomy of the fistula, (2) draining any associated infectious material, (3) eradicating the fistulous tract through medical or surgical therapies, and (4) preventing recurrence of fistulas. Evaluation and therapeutic decisions require close collaboration between the gastroenterologist and surgeon. Appropriate evaluation should include identification of septic complications, delineation of the fistulous tract including the origin and terminus of the fistula, and determination of the extent of bowel involvement with active CD. Drainage of abscesses and control of septic complications through the placement of drains or setons is essential. Conservative therapy with avoidance of sphincter muscle-cutting procedures is the standard approach. The appropriate approach to asymptomatic patients is uncertain because there are little data to indicate if treatment alters the natural course of disease.
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Affiliation(s)
- Thomas A Judge
- Gastroenterology Division, Robert Wood Johnson Medical School, Cooper University Hospital, University of Medicine and Dentistry of New Jersey, 401 Hadden Avenue, Room 374, Camden, NJ 08103, USA
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19
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Shaer AJ, Stewart LR, Cheek DE, Hurray D, Self SE. IgA antiglomerular basement membrane nephritis associated with Crohn's disease: a case report and review of glomerulonephritis in inflammatory bowel disease. Am J Kidney Dis 2003; 41:1097-109. [PMID: 12722045 DOI: 10.1016/s0272-6386(03)00208-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A case of glomerulonephritis in a 35-year-old man with Crohn's disease is described here. The patient presented with severe diarrhea, nephrotic range proteinuria, hematuria, microangiopathic hemolytic anemia, thrombocytopenia, hypocomplementemia, acute renal failure requiring hemodialysis, cryoglobulinemia, and extensive thrombotic gangrene of the distal upper and lower limbs. The patient did not respond to plasmapheresis and steroid therapy and died of upper gastrointestinal bleeding. Renal tissue obtained at autopsy showed IgA-mediated antiglomerular basement membrane crescentic glomerulonephritis. Linear staining of the glomerular basement membrane by non-IgG antibodies is quite unusual with only 11 cases previously reported in the worldwide literature, 8 caused by IgA. Glomerulonephritis is a rarely reported extraintestinal manifestation of inflammatory bowel disease, and there are only 24 previously described cases that are reviewed and summarized in this report. Glomerulonephritis occurred in the setting of active bowel inflammation in all cases, circulating immune complexes were found in nearly half the cases, and serum complements usually were normal. Renal insufficiency and nephrotic range proteinuria were typically present at the time of diagnosis of glomerulonephritis and most often improved in parallel with treatment of the gastrointestinal disorder. The histologic findings were varied and included membranoproliferative glomerulonephritis, mesangioproliferative glomerulonephritis, membranous nephropathy, IgA nephropathy, and IgM nephropathy. Thus, the authors present the first case of glomerulonephritis caused by antiglomerular basement membrane disease in association with inflammatory bowel disease.
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Affiliation(s)
- Andrea J Shaer
- Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, USA.
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20
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Abstract
A variety of common, gastrointestinal diseases result in significant genitourinary tract pathology. In general, knowledge of these associated disease processes permit rapid and accurate diagnosis and treatment. The underlying thread is the recognition of one pathophysiological process to explain patterns of a single disease.
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Affiliation(s)
- Michael G Oefelein
- Case Western Reserve University, School of Medicine, University Urologists of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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21
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Abstract
Patients with nephrolithiasis may have coexistent diseases that play a causative role in stone formation. A stone event may be the initial manifestation of the disorder and the urologist may play a major diagnostic role. Regulation or correction of the disorder may eradicate or dramatically attenuate stone activity. In some patients, metabolic abnormalities persist, however, and the therapeutic strategies that were reviewed in this manuscript may need to be implemented. Stone disease may also be induced by drugs that are used to treat a number of disease processes. When this occurs, the drug will usually need to be discontinued and alternative therapy should be instituted.
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Affiliation(s)
- Brian R Matlaga
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1094, USA
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22
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Parks JH, Worcester EM, O'Connor RC, Coe FL. Urine stone risk factors in nephrolithiasis patients with and without bowel disease. Kidney Int 2003; 63:255-65. [PMID: 12472791 DOI: 10.1046/j.1523-1755.2003.00725.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The prevalence of nephrolithiasis among patients with bowel disease is higher than in the general population. We examined urine stone risk factors and clinical characteristics of these patients, contrasted with a large group of stone forming patients without systemic disease. METHODS A total of 180 patients with bowel disease were compared with a group of 2048 nephrolithiasis patients with calcium or uric acid stones and without systemic diseases. Bowel diseases included inflammatory bowel disease with and without bowel resections, bowel resections from cancer or trauma, and bypass procedures for obesity or hypercholesterolemia. Urine stone risk factors, stone rates, stone compositions, and creatinine clearance were measured. RESULTS Compared to ordinary stone forming patients, bowel patients formed stones higher in rate of recurrence and in uric acid content. Uric acid content was highest when colon surgery had occurred. Urine volumes were low among all bowel patients except those with a bypass. Average creatinine clearance values were low among all bowel patients. Urine oxalate excretion was modestly elevated after small bowel resection, but very high with bypass. Supersaturations were increased mainly by low urine volume and-for uric acid-low pH. Patients with no surgery were indistinguishable from routine stone formers. CONCLUSIONS Low urine volume and pH are the main stone-forming abnormalities in bowel disease patients. Hyperoxaluria is extreme after bypass, but only modest after small bowel surgery. In the absence of surgery, bowel disease patients with stones cannot be distinguished from common stone formers by comprehensive stone risk measurements.
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Affiliation(s)
- Joan H Parks
- Nephrology Program and Urology Program, University of Chicago, Chicago, Illinois 60637, USA
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23
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Abstract
Crohn's disease often is detected in adolescents with nonspecific gastrointestinal complaints. Extraintestinal complications are common but usually follow the onset of the bowel complaints. We present an unusual case in which scrotal swelling was the first symptom in a patient discovered to have Crohn's disease.
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Affiliation(s)
- S F Simoneaux
- Department of Radiology, Egleston Children's Hospital at Emory, Atlanta, GA 30322-1101, USA
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24
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Abstract
Crohn's disease frequently can affect the genitourinary system, mainly in the form of urinary fistulae and urolithiasis. Diagnostic evaluation of fistulae associated with Crohn's disease has improved with the increasing use of computed tomography and MR imaging, along with other diagnostic modalities. Resective surgery is the main treatment in this group of patients. Kidney stones are common because of metabolic derangements and dehydration; however, these can be treated adequately with minimally invasive procedures, such as extracorporeal shock-wave lithotripsy, ureteroscopy, and percutaneous surgery. In addition, medical therapies can prevent recurrent stones.
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Affiliation(s)
- A N Manganiotis
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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25
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Sato S, Sasaki I, Naito H, Funayama Y, Fukushima K, Shibata C, Masuko T, Ogawa H, Ueno T, Hashimoto A, Matsuno S. Management of urinary complications in Crohn's disease. Surg Today 1999; 29:713-7. [PMID: 10483744 DOI: 10.1007/bf02482314] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Among the 127 patients who underwent surgical treatment for Crohn's disease at Tohoku University Hospital, urinary complications were noted in 13 patients (10.2%), including urolithiasis in 6 patients (4.7%), a ureteral obstruction in 4 (3.1%), and urinary fistula in 3 (2.4%). In patients with urolithiasis, conservative therapy was effective. An ureteral obstruction was detected on the right side in all 4 of these cases because of the inflamed terminal ileum. In 2 of the 4 cases, the symptoms improved by either preoperative total parenteral nutrition or elemental diet therapy. A resection of the inflamed intestine was necessary in all cases. In patients with urinary fistulas, a resection of the inflamed intestine combined with a reconstruction of the urinary tract was carried out after total parenteral nutrition. In conclusion, conservative therapy with preoperative total parenteral nutrition or elemental diet therapy proved to be effective for a ureteral obstruction since it improved the intestinal inflammation. As a definitive treatment, surgery is still necessary for the management of urinary fistulas and ureteral obstruction. Based on our findings, patients with urolithiasis in Crohn's disease should thus be treated conservatively in the same way as patients without Crohn's disease.
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Affiliation(s)
- S Sato
- First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan
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26
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Abstract
The cause of urinary stone disease can now be detected in approximately 80% of patients. Effective treatment can substantially reduce the recurrence of urinary calculi. Proper therapy depends on a thorough understanding of the physiology of calcium, oxalate, uric acid, cystine, and struvite formation and the medication developed for prevention. This article reviews the physiologic basis of urinary stone management in a straightforward, understandable fashion.
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Affiliation(s)
- S P Dretler
- Department of Urology, Harvard Medical School, Boston, Massachusetts, USA
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27
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Abstract
Renal and urologic complications are not uncommon in patients with inflammatory bowel disease, and can be directly or indirectly related to the underlying disease process or its treatment. Many of these patients have asymptomatic disease, or the urinary symptoms are nonspecific or overshadowed by bowel symptoms. By the time a urinary complication is considered, significant disease progression or renal damage may have occurred. These risks necessitate a high degree of diligence and periodic urologic evaluation as part of the long-term management of patients with inflammatory bowel disease.
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Affiliation(s)
- D S Pardi
- Inflammatory Bowel Disease Clinic, Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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28
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D'Amico A, Ficarra V, Porcaro A, Puce R, Cicuto S, Malossini G, Tallarigo C. L'eziopatogenesi della fibrosi retroperitoneale: Etiopathogenesis of retroperitoneal fibrosis. Urologia 1998. [DOI: 10.1177/039156039806500213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The etiopathogenesis of retroperitoneal fibrosis is still obscure and probably multifactorial. Among the secondary forms due to demonstrable causes, the one caused by aorto-iliac atherosclerosis has recently been recognised. Its pathogenesis is linked to the low density oxidised lipoproteins of the atheromatous plaque, which are responsible for a local immunologic reaction. The most common form is still idiopathic or primitive, hypothetically related to genetic, environmental, vascular and/or immunologic factors. Idiopathic retroperitoneal fibrosis is sometimes associated with other sclerosing syndromes and/or systemic diseases. In such cases a common pathogenesis, probably immunologic may be postulated. After having illustrated the different categories of retroperitoneal fibrosis, the authors report their experience with 25 patients of whom 14 had idiopathic fibrosis and 11 secondary fibrosis. In the former group 11 patients (78.5%) smoked more than 10 cigarettes a day, while there was a history of prolonged professional exposure to asbestos in one case. The following associated pathologies were observed: hypertension in 7 cases (50%), ischemic cardiopathy in 2 (14.3%), diabetes mellitus in 2 (14.3%), multiple myeloma in 1 (7.1%) and juvenile rheumatoid arthritis in 1 (7.1%). The disease was also associated with other sclerosing pathologies in 3 cases: sclerosing cholangitis in 2 and Dupuytren's contracture in 1. The location of the fibrosis was typically periaortic in 13 cases (92.8%), as shown by CT. Lastly, 10 patients underwent immunosuppressive therapy with a favourable response, suggesting the probable immunologic pathogenesis of the disease.
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Affiliation(s)
- A. D'Amico
- Cattedra e Divisione Clinicizzata di Urologia - Università degli Studi - Verona
- Divisione Clinicizzata di Urologia, Ospedale Policlinico - Via delle Menegone - 37134 Verona - Italy
| | - V. Ficarra
- Cattedra e Divisione Clinicizzata di Urologia - Università degli Studi - Verona
| | - A. Porcaro
- Cattedra e Divisione Clinicizzata di Urologia - Università degli Studi - Verona
| | - R. Puce
- Cattedra e Divisione Clinicizzata di Urologia - Università degli Studi - Verona
| | - S. Cicuto
- Cattedra e Divisione Clinicizzata di Urologia - Università degli Studi - Verona
| | - G. Malossini
- Cattedra e Divisione Clinicizzata di Urologia - Università degli Studi - Verona
| | - C. Tallarigo
- Cattedra e Divisione Clinicizzata di Urologia - Università degli Studi - Verona
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29
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Rossetti SR, Randone D. Fistole Intestinali Spontanee E Provocate in Urologia: Patogenesi E Terapia Le Fistole Ileali. Urologia 1990. [DOI: 10.1177/039156039005700409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - D.F. Randone
- (Clinica Urologica dell'Università di Torino - Direttore)
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30
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Abstract
Extraintestinal and systemic manifestations occur commonly in patients with inflammatory bowel disease, specifically ulcerative colitis and Crohn's disease, and affect most all organ systems of the body. The occurrence of such widespread manifestations strongly suggests that these disorders are systemic in nature and may have a common mechanism. Extraintestinal manifestations may be incidental findings that cause no symptoms, but more commonly complicate the management of the underlying inflammatory bowel disease, being a source of considerable morbidity and mortality. Some extraintestinal manifestations not only correlate with a specific disease state but also with the location, extent, and degree of activity and disease. Most extraintestinal manifestations found in patients with inflammatory bowel disease involving the small intestine appear to correlate with some underlying pathophysiologic mechanism.
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Affiliation(s)
- G B Rankin
- Department of Gastroenterology, Cleveland Clinic Foundation, Ohio
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31
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Kavoussi LR, Yuan J, Andriole GL. Urethral fistula and history of bladder neoplasms. UROLOGIC RADIOLOGY 1989; 11:194-7. [PMID: 2512708 DOI: 10.1007/bf02926513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- L R Kavoussi
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, 63110
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32
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Kent GG, McGowan GE, Hyams JS, Leichtner AM. Hypertension associated with unilateral hydronephrosis as a complication of Crohn's disease. J Pediatr Surg 1987; 22:1049-50. [PMID: 3430314 DOI: 10.1016/s0022-3468(87)80518-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Obstructive uropathy with hydronephrosis is a well-known complication of Crohn's disease. The treatment for this condition is still controversial. This is the case study of a 14-year-old girl with documented right-sided obstructive uropathy secondary to Crohn's disease associated with renin-mediated hypertension secondary to her obstructive uropathy. The patient had complete resolution of her hypertension following surgery, which involved only resection of the involved bowel without ureterolysis.
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33
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34
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Abstract
A case of ureterocolic fistula as a result of an impacted lower ureteric stone is reported in which the diagnosis was made on antegrade pyelography.
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35
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Lippert MC, Teates CD, Howards SS. Detection of enteric-urinary fistulas with a noninvasive quantitative method. J Urol 1984; 132:1134-6. [PMID: 6502803 DOI: 10.1016/s0022-5347(17)50063-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The 51chromium test is an inexpensive, noninvasive test to evaluate patients for enteric-urinary fistulas. Of 11 patients studied the 51chromium test demonstrated correctly a fistula in 5 of 6 patients with fistulas and showed no lesion in all 5 without fistulas. Excretory urography, barium enemas, visible contrast medium, cystograms and upper gastrointestinal series failed to demonstrate the fistulas with similar accuracy. Cystoscopy suggested a possible lesion in 4 patients but was definite for a fistula in only 2 of those patients.
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36
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Coppola V, Verrengia D, Gallo S, Greco U, Rossi R, Plaitano G. Complicanze Urologiche Del Morbo Di Crohn: Aspetti Radiologici. Urologia 1984. [DOI: 10.1177/039156038405100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - U. Greco
- Divisione di Urologia dell'Ospedale di Eboli, Salerno
| | | | - G. Plaitano
- 3Divisione di Medicina dell'Ospedale San Leonardo di Salerno
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37
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D'Amico G, Cirro G, D'Amico A. Classificazione Delle Fibrosi Retroperitoneali E Fisiopatologia Della Malattia Di Ormond (). Urologia 1983. [DOI: 10.1177/039156038305000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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38
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Stein EJ, Banner MP, Pollack HM. Rectourethrocutaneous fistula in Crohn disease. UROLOGIC RADIOLOGY 1983; 5:103-5. [PMID: 6612911 DOI: 10.1007/bf02926780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Fistulae from the gastrointestinal tract to the urinary tract are a well-known complication of Crohn disease. The majority of these are ileovesical. On rare occasion, patients with perianal complications of regional ileitis or granulomatous colitis may develop rectourethrocutaneous fistulae. The authors have encountered 2 such patients and add them to the 3 previously reported cases in the English literature. Retrograde urethrography and voiding cystourethrography established the diagnosis.
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39
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Duong RB, Gelfand MJ, Volarich DT, Williams P. Urinary tract imaging--filling defect in the urinary bladder. Semin Nucl Med 1983; 13:383-5. [PMID: 6648540 DOI: 10.1016/s0001-2998(83)80050-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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40
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Abstract
Chronic inflammatory bowel disease, diverticulitis, and appendicitis may be complicated by genitourinary tract problems. Patients with these diseases occasionally present with a genitourinary problem as an initial complaint prior to diagnosis of the underlying primary bowel disease. The correct diagnosis in these difficult cases will be arrived at sooner if the genitourinary manifestations of inflammatory diseases of the bowel are actively considered.
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41
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Abstract
Conditions that are often associated with an increased incidence of renal anomalies include imperforate anus, congenital vertebral abnormalities, and Fanconi anemia; excretory urography should be done if such a condition is present. Urography is also useful to provide baseline data in conditions associated with later development of urinary problems, such as myelodysplasia, prune-belly syndrome, and exstrophy of the bladder. In addition, urography serves as a periodic check for complications of treatment (hydronephrosis, obstruction) in patients with urinary diversion. Certain signs, eg, dribbling, hematuria after mild trauma, unexplained pneumothorax or pneumomediastinum in a neonate, and neonatal abdominal mass, call for immediate urography. In many conditions that were formerly thought to be associated with major urinary abnormalities, urography is not called for. Such is the case in hypospadias, deformities of the external ear alone, and undescended testes. Dehydration is the only absolute contraindication to urography.
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42
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Krishna AV, Dhar N, Pletman RJ, Hernandez I. Spontaneous closure of ureterocolic fistula secondary to diverticulitis. J Urol 1977; 118:476-7. [PMID: 904064 DOI: 10.1016/s0022-5347(17)58070-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An 88-year-old woman with spontaneous closure of a ureterocolic fistula secondary to sigmoid diverticulitis is described. Initially, the patient was subjected to proximal transverse colostomy to divert the fecal stream. She was rehospitalized for a sigmoid colectomy, and left ureteral catheterization as well as a retrograde pyelogram showed spontaneous closure of the ureterocolic fistula. A review of the literature reveals that specific involvement of the ureter secondary to inflammatory bowel disease is rare. Most of the cases reported previously have alluded to active and radical measures. We do not recommend a radical resection in the acute stage, especially when the tissue planes may be obliterated owing to inflammation and difficulty in structure identification may lead to inadvertent injury.
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