Journal
NATURE CLINICAL PRACTICE NEPHROLOGY
Volume 4, Issue 12, Pages 693-697Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/ncpneph0955
Keywords
5-aminosalicylic acid; chronic renal impairment; Crohn's disease; tubulointerstitial nephritis
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Funding
- Medical Research Council [G0802138] Funding Source: Medline
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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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