Drug-Induced Nephrotoxicity in Inflammatory Bowel Disease

Abstract

Conservative management of inflammatory bowel disease (IBD) is based on a combination of drugs, including aminosalicylates (ASAs), steroids, antibiotics, immunosuppressives and biologic agents. Although various side effects have been related to treatment regimens, drug-induced nephrotoxicity is rather uncommon. Furthermore, it is often underestimated since renal function deterioration may be attributed to the underlying disease. The nephrotoxicity of ASAs and cyclosporine A seems well established, but recent data have suggested a possible role of biologic agents such as infliximab and adalimubab in renal impairment. The aim of this review is to summarize the nephrotoxic effects of medical treatment as well as to express possible caveats in the administration of novel agents in IBD.

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

“…The most common kidney histologic finding reported in association with 5-ASA is interstitial nephritis (4,37,38). The pathogenesis of this is unknown, and studies have been unable to identify a clear relationship between duration and dose of 5-ASA and the development of kidney disease (37,38). It is therefore thought to probably represent an idiosyncratic, delayed-type hypersensitivity that is independent of dose and duration of exposure (39).…”

Nefrite intersticial induzida por mesalazina em gêmeos monozigóticos portadores de doença inflamatória intestinal – relato de caso

“…8,11 O acometimento renal mais prevalente da mesalazina é a nefrite intersticial, seja agudo ou crônico, mas também é associado ao seu uso: glomerulonefrite, nefropatia por lesão mínima com síndrome nefrótica e há até mesmo relato de diabetes insipidus nefrogênica. 12,13 Alguns autores questionam se o substrato genético também não teria influência para o desenvolvimento dessas lesões. Um trabalho sugeriu que alterações de alelos do sistema leucocitário humano (HLA) poderia ser um fator de risco, mas com baixa frequência e utilidade clínica limitada.…”

Nephrolithiasis as a common urinary system manifestation of inflammatory bowel diseases; a clinical review and meta-analysis

“…Treatment with 5-ASA may cause renal toxicity that include glomerulonephritis, change in nephropathy with interstitial nephritis and nephrotic syndrome, which in these cases might be associated with nephrogenic diabetes ( 61 , 62 ).…”