BACKGROUND: Glomerular diseases are described in patients with active ulcerative colitis (UC). Likely drug-induced interstitial nephritis, and nephrotic syndrome due to minimal change disease, have been reported in a few patients with UC on treatment with mesalazine and sulfasalazine (5-ASA). We describe a 33 year-old patient with a 5-years history of UC who recently developed nephrotic syndrome associated with microscopic haematuria. Blood pressure and renal function were normal. The patient was on azathioprine (AZA), mesalazine and sulfasalazine during the last year for his colitis, with good control of bowel disease. Renal biopsy revealed a focal segmental glomerulosclerosis (FSGS) associated with mesangial IgA deposits; no signs of interstitial nephritis were found. 5-ASA was discontinued, AZA was reduced and a rapid remission of the nephrotic syndrome was observed after 6 weeks of steroid therapy (1 mg/kg/day per os) associated with ramipril 5 mg/day, with a follow-up of 9 months. CONCLUSIONS: To our knowledge this is the first report of UC and GSFS associated with IgA deposits. The occurrence of nephrotic syndrome during UC is suggestive of an association between UC and FSGS, but a possible role of mesalazine and /or sulfasalazine in its pathogenesis cannot be excluded. Mesangial IgA deposits could be an "occasional" further occurrence, considering the chronic inflammation of colonic mucosa and the altered immune response of patients with UC.
BACKGROUND:Glomerular diseases are described in patients with active ulcerative colitis (UC). Likely drug-induced interstitial nephritis, and nephrotic syndrome due to minimal change disease, have been reported in a few patients with UC on treatment with mesalazine and sulfasalazine (5-ASA). We describe a 33 year-old patient with a 5-years history of UC who recently developed nephrotic syndrome associated with microscopic haematuria. Blood pressure and renal function were normal. The patient was on azathioprine (AZA), mesalazine and sulfasalazine during the last year for his colitis, with good control of bowel disease. Renal biopsy revealed a focal segmental glomerulosclerosis (FSGS) associated with mesangial IgA deposits; no signs of interstitial nephritis were found. 5-ASA was discontinued, AZA was reduced and a rapid remission of the nephrotic syndrome was observed after 6 weeks of steroid therapy (1 mg/kg/day per os) associated with ramipril 5 mg/day, with a follow-up of 9 months. CONCLUSIONS: To our knowledge this is the first report of UC and GSFS associated with IgA deposits. The occurrence of nephrotic syndrome during UC is suggestive of an association between UC and FSGS, but a possible role of mesalazine and /or sulfasalazine in its pathogenesis cannot be excluded. Mesangial IgA deposits could be an "occasional" further occurrence, considering the chronic inflammation of colonic mucosa and the altered immune response of patients with UC.