Significant kidney impairment in pediatric inflammatory bowel disease and practice points for pediatric gastroenterologists.

OBJECTIVES

Children with inflammatory bowel disease (IBD) have an increased risk of developing kidney disorders, which may cause significant kidney function impairment (SKI) or lead to chronic kidney disease (CKD). In this study we aimed to provide insights in causes and diagnoses of SKI cases and to provide recommendations for pediatric gastroenterologists for children with IBD and SKI.

METHODS

Cases of SKI in children with IBD (<19 years) were collected from the international, prospective PIBD-SETQuality Safety Registry. A monthly survey was sent to participating pediatric gastroenterologists to report cases of SKI (defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2). Additionally, a panel consisting of 16 members (including experts in pediatric IBD and nephrology) rated the most likely cause of the cases and formulated recommendations for screening, follow-up and referral for children with IBD and SKI.

RESULTS

Between November 1, 2016 and December 31, 2023, 42 cases of SKI were eligible for analysis. Tubulo-interstitial nephritis (TIN) was the most common diagnosis (n = 15). Sixteen (38%) cases were confirmed with renal biopsy (10 cases of TIN). Twelve patients developed CKD. IBD medication was the most frequently reported cause (n = 15), however, there was low concordance between panelists about the most likely etiology (Fleiss' kappa 0.143 and 0.102).

CONCLUSIONS

This is the first prospective study to report cases of SKI in children with IBD. SKI may lead to CKD. Confirming the etiology of the SKI proved to be very challenging. The study provides recommendations for screening and follow-up of SKI in children with IBD.

TRIAL REGISTRATION: NCT03571373, date of registration: June 27, 2018, URL: https://clinicaltrials.gov/study/NCT03571373.