RENAL FUNCTION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Pojavnost upalnih bolesti crijeva (UBC) posljednjih je nekoliko godina u stalnom porastu, pa tako raste i pojavnost njihovih ekstraintestinalnih očitovanja i sistemskih komplikacija. Bubrežna očitovanja UBC-a, iako rijetka, mogu dovesti do razvoja završnog stadija kronične bubrežne bolesti i posljedične potrebe za nadomještanjem bubrežne funkcije hemodijalizom i/ili transplantacijom bubrega. To su prije svega bubrežni kamenci čija je pojavnost i do pet puta češća nego u zdravih pojedinaca, ali i parenhimske bolesti poput IgA nefropatije, tubulointersticijskog nefritisa i sekundarne amiloidoze. S obzirom na nefrotoksičnost ciklosporina i mogućnost razvoja akutnog tubulointersticijskog nefritisa uz mesalazin, pri njihovoj uporabi preporučuje se redovita kontrola bubrežne funkcije. Uvode se i novi lijekovi radi sekundarne ili tercijarne prevencija oksalatnih kamenaca (probiotici s Oxalobacter formigenes) i glomerularnih IgA depozita (baminercept), kojima se nastoji očuvati bubrežna homeostaza. Dosadašnji rezultati pokazuju da infl iksimab može usporiti napredovanje amiloidoze bubrega. Lijek se pokazao sigurnim u bolesnika na hemodijalizi, naročito ako je potrebno brzo djelovati na upalu crijeva. Ishodi liječenja i prognoza su bolji kod primatelja transplantiranog bubrega nego u iste skupine UBC bolesnika s transplantiranom jetrom. Smatra se kako je to posljedica snažnije imunosupresivne terapije u bubrežnih primatelja.The incidence of infl ammatory bowel diseases (IBD) has rapidly increased over the last few years, as have increased their extraintestinal manifestations and systemic complications. Renal manifestations of IBD, although rare, can lead to chronic renal failure and the need for renal replacement therapy with either dialysis or renal transplantation. Renal manifestations are primarily renal calculi, which have a tendency of appearing up to fi ve times more frequently in IBD patients than in the general population, but also parenchymal diseases as IgA nephropathy, tubulointerstitial nephritis and secondary amyloidosis. Due to nephrotoxicity of cyclosporine and possible development of acute tubulointerstitial nephritis as a consequence of mesalazine treatment, regular renal function monitoring is mandatory. New therapeutic options are being introduced for secondary and tertiary prevention of oxalate stones (probiotics featuring Oxalobacter formigenes) and glomerular IgA deposits (baminercept), with the intent of preserving renal homeostasis. Infl iximab can prevent further renal deterioration in kidneys affected by amyloidosis. Furthermore, its use in patients on hemodialysis has been proven to be safe and necessary if rapid suppression of intestinal infl ammation is required. Patients with IBD having undergone renal transplantation end to have better outcomes compared to liver transplant recipients. This is postulated to be the effect of more intensive immunosuppressive therapy in kidney recipients