Beyond the Bowel: A Case of Ulcerative Colitis-Associated Membranous Nephropathy

Introduction: Glomerulonephritis is a rare extraintestinal manifestation of Ulcerative Colitis (UC) and presents clinical challenges in management. We present a case of glomerulonephritis in a 68-year-old male with a history of UC, highlighting the importance of vigilance for extraintestinal manifestations in inflammatory bowel diseases. Case Description: A 68-year-old male with UC on adalimumab presented with worsening lower extremity edema, dyspnea on exertion, and hematochezia. Laboratory investigations revealed anemia, elevated serum creatinine, and nephrotic range proteinuria. Immunological workup demonstrated positive Anti-Phospholipase A2 receptor IgG. Renal biopsy confirmed Membranous Nephropathy. Treatment initially involved corticosteroids, adalimumab, and lisinopril, with subsequent adjustments including infliximab, losartan, azathioprine, and empagliflozin due to UC flares and renal deterioration. Transition to Ustekinumab led to improved UC symptoms and reduced proteinuria. Discussion: The association between UC and glomerulonephritis underscores the need for comprehensive screening and monitoring of renal function in UC patients. The positive response to corticosteroid therapy suggests an autoimmune component, necessitating further research into underlying immunological pathways. This case emphasizes the challenges in managing UC-related glomerulonephritis and highlights the importance of multidisciplinary care. Early recognition of extraintestinal manifestations is crucial for optimizing patient outcomes, warranting further studies for better therapeutic strategies.