From the Department of Paediatric Nutrition and Gastroenterology, Reference Centre for Rare Digestive Diseases, Trousseau Hospital, APHP, Paris, France.
the Department of Paediatric Nephrology, Trousseau Hospital, APHP, Paris, France.
J Pediatr Gastroenterol Nutr. 2023 Mar 1;76(3):331-337. doi: 10.1097/MPG.0000000000003682. Epub 2022 Dec 13.
Renal and/or urinary manifestations (RUM) have been reported in pediatric patients with inflammatory bowel disease (IBD) but their incidence is unknown. The aims of this study were to assess the prevalence and causes of these manifestations in children with IBD and determine the causal link with 5-aminosalicylic acid (5-ASA) treatment.
A retrospective observational study was performed with children with diagnosis of IBD. All children with RUM during follow-up and/or impaired renal function [estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m 2 ] were identified.
Of 228 included patients, 9 (3.9%) had a RUM during follow-up [follow-up: 5 years (1-12 years)] at a median age of 16 years (8-17 years). It concerned 7 of 171 patients with Crohn disease and 2 of 57 with ulcerative colitis. Seven patients were taking 5-ASA at the time of the RUM. Only 1 of them had an iatrogenic renal complication related to this treatment. Patients with RUM had a more severe disease with increased anti-tumor necrosis factor-α use ( P = 0.031), more abscesses ( P = 0.003), and a higher rate of digestive surgery ( P = 0.04). For the whole cohort, a significant decrease in eGFR was found during follow-up (121 vs 107 mL/min/1.73 m 2 , P < 0.001). At the end of follow-up, 38 of 202 (19%) patients had an eGFR < 90 mL/min/1.73 m 2 .
In children with IBD, RUM can occur, independently of treatment with 5-ASA. During follow-up, a significant decrease in eGFR was observed. We suggest monitoring renal function in all patients with IBD.
儿科炎症性肠病（IBD）患者可出现肾脏和/或泌尿系统表现（RUM），但目前尚不清楚其发病率。本研究的目的是评估 IBD 患儿这些表现的发生率和病因，并确定与 5-氨基水杨酸（5-ASA）治疗的因果关系。
对诊断为 IBD 的儿童进行回顾性观察性研究。所有在随访期间出现 RUM 和/或肾功能受损[估算肾小球滤过率（eGFR）<90mL/min/1.73m2]的患儿均被识别。
在 228 例纳入的患儿中，9 例（3.9%）在随访期间出现 RUM[随访时间：5 年（1-12 年）]，中位年龄为 16 岁（8-17 岁）。这 9 例患儿中，7 例为克罗恩病，2 例为溃疡性结肠炎。7 例 RUM 患儿正在服用 5-ASA。其中仅 1 例与该治疗相关发生医源性肾脏并发症。发生 RUM 的患儿疾病更严重，抗肿瘤坏死因子-α的使用增加（P=0.031），脓肿更多（P=0.003），且消化手术的发生率更高（P=0.04）。在整个队列中，eGFR 在随访期间显著下降（121 比 107mL/min/1.73m2，P<0.001）。随访结束时，202 例患儿中有 38 例（19%）eGFR<90mL/min/1.73m2。
在 IBD 患儿中，RUM 可发生，且与 5-ASA 治疗无关。在随访期间，eGFR 显著下降。我们建议所有 IBD 患儿都监测肾功能。
