P-022 Renal Disease Associated with Crohnʼs Disease, Mesalamine and Infliximab

Abstract

15 year old female with 5 year history of Crohn's Disease (CD) ileocolitis developed increasing serum creatinine concentrations over a 6 month period. She was steroid and mesalamine (50 mg/kg/day) dependant for 1 year after diagnosis of CD prompting addition of Remicade therapy at 5 mg/kg/dose every 8 weeks. Relapsing disease continued and dose of Remiade was increased to 10 mg/kg every 8 weeks 2 years post diagnosis. Interval of administration was gradually shortened to every 4 weeks by 3 years post diagnosis. Symptoms stabilized on this regimen. However, ESR increased to 50–60 for the 6 months period (4.5–5 yrs post CD diagnosis) prior to renal disease recognition. No urinary tract symptoms noted, Creatinine 1.22 mg/dL, Creatinine Clearance 53 mL/min/1.73 m2, ANA 1:320. No other serum immune abnormalities detected. Renal Biopsy revealed active chronic tubulointerstitial nephritis, mesangioproliferative immune complex glomerulopathy with focal global glomerulosclerosis. Discontinuation of Remicade and mesalamine led to rapid decrease in ESR to 11, and gradual decrease over the next year in serum creatinine to range of 0.99–1.07 mg/dL and rise in creatinine clearance to 68 mL/min/1.73 m2 which although improved continues to be compatible with quiescent chronic renal disease stage 2. Biweekly Humira 40 mg/dose was initiated 3 months after discontinuing pentasa and Remicade. Differential diagnoses of renal disease incriminate: CD, mesalamine, infliximab or autoimmune disease and or combination of these processes. Clinical History recounted above. Clinical History recounted above. Included in abstract.