الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 155 |  |  |
| | | from | 155 | | |
Abstract
Inflammatory bowel diseases (IBD) are chronic, immune mediated characterized by abdominal pain, anemia, bleeding, diarrhea, and weight loss. They may be associated with other disorders, including ankylosing spondylitis, arthritis, cholangitis, erythema, iritis, and uveitis. Ulcerative colitis and Crohn’s disease are the two most common inflammatory bowel diseases. There are subtypes of each of these diseases, based on what part of the digestive tract is affected. Several other diseases also can cause inflammation of the large intestine as indeterminate colitis, microscopic colitis, diversion colitis and Bechet’s disease. These diseases are less common, and they often have similar symptoms. For these reasons, they can be hard to diagnose.
Extra intestinal manifestations (EIMs) can be classified into 3 groups. The first group has a direct relationship with intestinal disease and parallels the disease process. Includes episcleritis, erythema nodosum EN), oral aphthous ulcers, and periarticular arthritis. The second group of EIM seems to develop and progress independent from intestinal disease activity and may simply reflect the susceptibility of these patients to autoimmune disorders. This group includes ankylosing spondylitis (AS) and uveitis. The third group consists of EIMs that have an unclear relationship with intestinal inflammation. This group includes pyoderma gangrenosum and PSC
Renal involvement in IBD has been considered as an extra intestinal manifestation and has been described in both CD and UC. The most frequent renal involvements in patients with inflammatory bowel disease are nephrolithiasis, tubulointerstitial nephritis, glomerulonephritis, amyloidosis, renal carcinoma and renal failure which may ultimately require hemodialysis.
The prevalence of nephrolithiasis among patients with IBD is higher than in the general population, ranging from 12% to 28%, especially in patients with IBD who have undergone surgical bowel procedures, such as total colectomy with ileostomy, small bowel resection or intestinal bypass. Diarrhea and malabsorption, often described in IBD patients, are risk factors for renal stone formation.
Glomerulonephritis (GN), defined as a spectrum of renal diseases of varied etiology and clinical presentations that are characterized by clinical and histological evidence of glomerular damage. As it is not strictly a single disease, its presentation depends on the specific disease entity: it may present with isolated hematuria and/or proteinuria or as a nephrotic syndrome, a nephritic syndrome, acute kidney injury, or chronic kidney disease.
Tubulointerstitial nephritis (TIN) is characterized by an immune-mediated infiltration of the kidney interstitium by inflammatory cells, leading to no oliguric or oliguric acute kidney injury (AKI). Less frequently, the interstitial inflammation can lead to chronic changes, with subsequent development of chronic kidney disease (CKD). Numerous genetic and environmental factors can cause or contribute to TIN development. Aspects of histologic diagnosis or associated systemic disease can aid knowing the etiology.
Amyloidosis is a rare disease that occurs when amyloid proteins are deposited in tissues and organs. Amyloid proteins are abnormal proteins that the body cannot break down and recycle, as it does with normal proteins. When amyloid proteins clump together, they form amyloid deposits. The buildup of these deposits damages a person’s organs and tissues. Amyloidosis can affect different organs and tissues in different people and can affect more than one organ at the same time. Amyloidosis most affects the kidneys, heart, nervous system, liver, and digestive tract.
There are few data in the literature focused on the incidence of renal insufficiency (RI) in patients with IBD found that the prevalence of RI in a population of IBD patients was 1.99% in CD patients and 0.01% in UC patients.
Patients with IBD have an increased risk for both intestinal and various extra-intestinal malignancies. Although only limited evidence is available, it has been suggested that immunosuppression in IBD patients may increase the risk for a variety of solid malignancies, such RCC. Indeed, RCC occurs more frequently in post-transplantation patients exposed to immunosuppressive medication. In addition, the risk for urinary tract cancers in IBD patients on thiopurines seems to be elevated.
RCC is the most common adult renal cancer and the most lethal of the urological malignancies, with smoking, hypertension, and obesity being the main risk factors. Its incidence is increasing and pronounced for renal masses less than 4 cm as a consequence of incidental findings in13–27% of abdominal imaging, of which 80–85% are RCC. RCC is also more common in acquired cystic renal disease.