KIDNEY DISORDERS IN CD
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Extraintestinal Complications: Kidney Disorders
The kidneys, which filter the body's blood supply and eliminate waste through urine, are essential to good health. Serious kidney complications associated with IBD are rare, but some not so serious ones occur more frequently.
Kidney stones are probably the most commonly encountered kidney complication of IBD -- particularly oxalate stones. Kidney stones are more common in Crohn's patients with disease of the small intestine than in the general population because of fat malabsorption. Fat binds to calcium, leaving oxalate (a type of salt) free to be absorbed and deposited in the kidney, leading to the formation of stones. The situation is worse for people who have had a number of small bowel resections and are therefore more prone to dehydration. Their urine is more concentrated, a condition that is more conducive to stone formation. Kidney stone treatment calls for an increased fluid intake together with a low-oxalate diet (one that's rich in juices and vegetables). Gallstones are more common in patients with Crohn's disease of the ileum than the general population, because the diseased ileum no longer absorbs bile salts, which are necessary to make cholesterol soluble in bile.
Uric acid stones are caused by increased uric acid absorption in the injured colon. If the kidney stones do not pass spontaneously, surgical or endoscopic (with a tube) removal may be necessary.
Hydronephrosis is a direct anatomical complication of IBD, particularly Crohn's disease. This is an obstruction of the ureter, which is the principal tube connecting the kidney to the bladder. When it becomes obstructed because of inflammation or the presence of scar tissue, urine is blocked. It generally occurs with the right kidney because that is the one closest to the terminal ileum -- the bottom segment of the small intestine and the most common site of Crohn's disease. Surgical intervention is usually required, with removal of the inflamed tissue and neighboring section of bowel so that urinary flow is restored.
Fistulas are abnormal connections either within the intestine or between the intestine and other organs. When a fistula develops between the intestine and the bladder or the ureter, the result is frequent urinary tract infections and sometimes air in the urine. Men are more frequently affected than women, and although drug treatment is often effective, surgery may be required when medication does not work.
Amyloidosis is a condition marked by deposits of an abnormal protein in various tissues, including the kidneys. Although it occurs more in Crohn's disease than in ulcerative colitis, it is still a relatively rare disorder and is generally only seen in cases of long-term and severe disease. There is no particular treatment.
Glomerulonephritis is another rare complication seen in IBD. An abnormality in the glomerulus, a cluster of blood vessels in the kidney, produces a lesion in the kidney which hinders its filtering ability. In extreme cases, kidney dialysis or transplantation may be required.
Drug toxicity is occasionally responsible for kidney complications,
although these generally resolve when the drug in question is discontinued.
The immunosuppressive drug cyclosporine,
for example, may cause
constriction of the blood vessels in the kidneys and thereby alter kidney
function. If this is not picked up quickly, kidney failure may result.
Similarly, sulfasalazine and the 5-ASA drugs such as mesalamine (Pentasa, Asacol and others) may produce kidney toxicity. Kidney function should be monitored closely in people with IBD, regardless of which medication they are receiving.
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