5-Aminosalicylates and renal function in inflammatory bowel disease

Abstract

Nephrotoxicity has been described in some patients with inflammatory bowel disease (IBD) treated with 5-aminosalicylic acid (5-ASA). Studies with 5-ASA treatment in which serum creatinine or creatinine clearance was measured regularly show that nephrotoxicity is exceptional (mean rate of only 0.26% per patient-year). There have been several case reports, including 46 patients, of renal disease associated with 5-ASA treatment in patients with IBD. 5-ASA treatment-related nephrotoxicity is reported most often within the first 12 months, but also delayed presentation after several years has been shown. The absence of a clear relationship between 5-ASA dose and the risk of nephrotoxicity suggests that this complication is idiosyncratic rather than dose-related. Most of the patients with renal disease associated with 5-ASA treatment suffered interstitial nephritis, with symptoms and signs being nonspecific, which may delay detection for many months. The nephrotoxicity potential of mesalazine and sulfasalazine seems to be similar. The risk with different oral preparations of 5-ASA is probably too small to influence the choice of agent. Mesalazine should be withdrawn when renal impairment manifests in a patient with IBD; if this does not result in a fall in serum creatinine, then renal biopsy should be considered. A trial of high-dose steroid may be recommended in patients whose renal function does not respond to drug withdrawal. The optimal monitoring schedule of serum creatinine in patients receiving 5-ASA treatment remains to be established, as there is no evidence to date that either the test, or the frequency of testing, improves patient outcomes.

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

“…It is recommended that serum creatinine should be measured before initiating treatment with mesalamine or its prodrugs, and periodically while on treatment. Although it may be reasonable to monitor serum creatinine at 3 -6 months intervals during the fi rst year of mesalamine treatment, and then annually thereaft er, at present the optimal monitoring schedule of serum creatinine in patients treated with mesalamine remains to be determined, as there is no evidence currently to suggest that the frequency of testing improves patient outcomes ( 99 ).…”

Mesalazine-Induced Interstitial Nephritis

“…[1,2,4] However, several studies suggest an association between the use 5-ASA in patients with IBD and the development of chronic tubulo-interstitial nephritis. [1][2][3][4][5][6][8][9][10] Apart from lesions associated with 5-ASA treatment, the IBD itself may also induce renal impairment. [4,7] Nephrotoxicity is exceptional (mean rate of only 0.26% per patient-year) in 5-ASA treated patients.…”

“…[4,7] Nephrotoxicity is exceptional (mean rate of only 0.26% per patient-year) in 5-ASA treated patients. [1] While the incidence of this adverse event in the population of patients with IBD treated with mesalazine is low, [4,6] the morbidity in an affected individual is high, as there is 61% frequency of residual chronic renal insufficiency with 13% of patients developing end-stage renal disease. [3] The absence of a clear relationship between 5-ASA dose and the risk of nephrotoxicity suggests that this complication is idiosyncratic rather than dose-related.…”

“…[1,2] Mesalazine-induced interstitial nephritis is a rare complication that occurs in fewer than 1 out of 500 treated patients. This complication shows a male predominance, an absence of specific symptoms or findings in urinalysis, a high frequency of chronic renal insufficiency and a favorable response of active nephritis to steroid therapy.…”

“…This complication shows a male predominance, an absence of specific symptoms or findings in urinalysis, a high frequency of chronic renal insufficiency and a favorable response of active nephritis to steroid therapy. [1][2][3][4][5][6] …”