Acute interstitial nephritis due to mesalazine

Abstract

A case of mesalazine-induced acute interstitial nephritis (AIN) in a 41-year-old patient with ulcerative colitis (UC) is reported here. Clinical symptoms such as fever and arthralgia, and laboratory findings such as eosinophilia and renal failure suggested AIN, which was confirmed by biopsy. With withdrawal of mesalazine and intravenous methylprednisolone the patient's renal function was recovered. It is observed that early discontinuation of mesalazine is associated with amelioration of interstitial nephritis in most patients, so the recommendation is that patients receiving mesalazine should undergo routine monitoring of renal function. Delayed diagnosis may lead to permanent renal function impairment.

Sulfasalazine induces mitochondrial dysfunction and renal injury

“…Sulfasalazine-induced mitochondrial dysfunction might lead to the energy crisis, tubular cells injury, and defect in ion and electrolytes reabsorption. The electrolyte imbalance in case reports of sulfasalazine or mesalazine [45][46][47][48] might be attributed to insufficient ion reabsorption (an energy dependent process) in the kidney.…”

The Histopathologic Spectrum of Kidney Biopsies in Patients with Inflammatory Bowel Disease

“…Parenchymal kidney disease is rare but has been well documented in the worldwide literature as case reports describing GN (7)(8)(9)(10), minimal-change disease (11,12), secondary amyloidosis (13)(14)(15), and interstitial nephritis (16)(17)(18)(19).…”

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.…”

“…[1] Routine monitoring of renal function is simple and inexpensive and could prevent this outcome. [1][2][3]5,6,[8][9][10] 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. Based on the available data, serum creatinine should be estimated prior to commencing treatment and monthly for the first three months, then every three months for the next nine months, every six months thereafter, and annually after five years of treatment.…”

“…A trial of high-dose steroid may be recommended in patients whose renal function does not respond to drug withdrawal, [1] as corticotherapy was shown to have a favorable outcome. [1,3,[8][9][10] The personal history and clinical findings including histology results of renal biopsy in our patient were indicative of mesalazineinduced nephritis. The corticotherapy resulted in overall improvement of both clinical state and laboratory markers.…”