P2267 - The Kidney Surpirse at the Inflammation Dinner

Sibgha Farooq, MBBS¹, Muhammad Bilal Ibrahim, MD^2
1University of Health Sciences, Lahore, Chicago, IL; ²John H. Stroger, Jr. Hospital of Cook County, Chicago, IL

Introduction: IBD (comprising Ulcerative Colitis and Crohn's disease) is frequently associated with thrombotic complications owing to a pro-inflammatory state that can lead to various complications. Although the site of thromboembolism is predominantly venous in origin, isolated renal vein thrombosis is very rare. To our knowledge, 2 case reports have been published so far on association between UC and RVT, and the available literature suggests that there may be a link between the two conditions.


Case Description/Methods: We present a case of a patient with UC who developed renal vein thrombosis as a 58 year old lady with a 6 year history of ulcerative colitis, diagnosed via colonoscopy. Patient was on mesalamine but noncompliant due to insurance limitations. She was admitted to the hospital from GI clinic with worsening abdominal pain and bloody diarrhea for management of acute ulcerative colitis flare. Labs were remarkable for elevated CRP and stool calprotectin and microcytic anemia. CT abdomen and pelvis revealed diffuse edema and thickening of colon consistent with acute UC flare and also showed incidental left renal vein thrombosis with hypoattenuation of mid and lower pole of kidney. She had a good response to prednisone and mesalamine for the IBD. For the renal vein thrombosis, Eliquis was initially started but due to insurance limitations, later switched to Coumadin and bridged with Lovenox. No invasive interventions or measures were undertaken as the kidney did not show any signs of acute decompensation, GFR and Creatinine remained stable throughout the course of hospital stay. Pt was sent home in stable condition and currently, she is being followed up in the outpatient department with frequent INR checks on coumadin. Of note, a recent renal duplex done after 6 months of regular anticoagulation management showed non further evidence of the thrombus and depicted a patent venous outflow in the bilateral kidneys.

Discussion: In conclusion, IBD is an independent risk factor for thromboembolism and RVT is a very rare complication. It can clinically mimic an IBD flare or another complication of IBD which can cause a delay in timely diagnosis and management. Therefore, it is important for clinicians to keenly assess IBD patients, especially those with unusual symptoms for presence of renal vein thrombosis for early recognition and comprehensive management.


Disclosures:


Sibgha Farooq, MBBS¹, Muhammad Bilal Ibrahim, MD². P2267 - The Kidney Surpirse at the Inflammation Dinner, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.