Crohn's disease (CD) and hepatitis C (HC) are known to have systemic manifestations with renal involvement. Membranoproliferative and membranous glomerulonephritis are well described with HC. Nephrolithiasis and obstructive uropathy are associated with CD, but glomerulonephritis is rarely reported. We report the case of a 17-year-old African American female with HC and CD but renal pathology atypical of either disease. The patient, who was not an IV drug user, had been diagnosed with HC when a liver biopsy showed a modified histologic activity index of 2/18, stage 1/6. ALT was normal, and she was not treated. Seven months later, she presented with 15% weight loss, bloody diarrhea, abdominal and joint pain, erythema nodosum, large, fleshy perianal tags, and hypertension. On admission, laboratory tests showed an ESR of 94 mm/h, CRP of 16 mg/dL, WBC count of 30,000/mm3, Hgb of 7 g/dL, platelet count of 830,000/mm3, creatinine of 1.5 mg/dL, BUN of 15 mg/dL, and albumin of 1.8 g/dL. Her liver function tests were normal. Quantitative cryoglobulin testing, HIV ELISA, ANA, RF, p-ANCA, and c-ANCA were negative. ASCA was negative; anti-OmpC IgA was positive. Stool culture and C. difficile were negative. Urine protein:creatinine ratio was 0.98 (normal < 0.2) and estimated creatinine clearance was 58 mL/min (normal 89-165 mL/min). Renal ultrasonography showed echogenic kidneys and no stones. CT abdomen/pelvis showed wall thickening of the entire colon. Sigmoidoscopy revealed severely friable mucosa with numerous pseudopolyps but focal preservation of vascularity. Histology was consistent with CD, with paucity of glands, cryptitis, crypt abscesses, and granulomata. Renal biopsy showed moderate global glomerulosclerosis, periglomerular chronic interstitial fibrosis,and diffuse mesangial hypercellularity, with no crescents. Immunofluorescence for IgG, IgM, IgA, C3, and amyloid stain were negative. To our knowledge, global glomerulosclerosis has not previously been described in patients with HC and/or CD.
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