Lesson of the week: Late onset interstitial nephritis associated with mesalazine treatment

Popoola, Joyce; Muller, A F; Pollock, Lucy; O’Donnell, Patrick; Carmichael, Paul L.; Stevens, Paul E.

doi:10.1136/bmj.317.7161.795

Cited by 43 publications

(38 citation statements)

References 8 publications

(9 reference statements)

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“…Then about one fifth of mesalazine is absorbed and later excreted by kidneys. Tubular and papillary necrosis after 5-ASA had been proved in the early 1970s 12 , cases of nephrotic syndrome both after sulfasalazine 11 and mesalazine 10 were described in the 1980 s. Nephrotoxicity was most frequently described with the preparation Asacol -the reason can be that the preparation has been sold for the longest time 2,3,6 . The 5-ASA structure is similar to that of salicylates and phenacetine and 5-ASA can cause nefropathy like the non-steroid antiinflammatory drugs (NSAIDs) -and the nephropathy reminds one of analgetic nephropathy characterized by interstitial nephritis and papillary necrosis 6,9 .…”

Section: Discussionmentioning

confidence: 99%

“…The early signs were sterile pyuria and the low urine specific weight, as in salicylates 6 . Usually, the renal impairment was asymptomatic, unveiled by regular follow up during hospitalization, for the relapse of IBD 1,2,3,6 . Only in one of the cases 5 there were six months of weight loss, fatigue and dyspnea and another case showed "foamed" urine, which was noticed by the patient 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients used 1.2 to 3 g of mesalazine daily at least for 12 months (interval 12 months to 7 years). Previously reported cases describe chronic interstitial nephritis occuring after months to years of mesalazine use 1,2,3,5,6,7,8,9 . We report the case of a young man with asymptomatic renal failure development after three weeks administration of mesalazine.…”

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confidence: 99%

“…It can be administered as sulfasalazine (5-ASA + sulfapyridine), mesalazine (5-ASA + resins) or olsalazine (5-ASA + 5-ASA). The recent trend prefers mesalazine and olsalazine to sulfasalazine due to their lesser frequent adverse effects but its potential myelotoxicity, hepatotoxicity and nephrotoxicity still must be considered 2,3 . Nephrotoxicity is manifested as indolent interstitial nephritis that -if not diagnosed and treated -can progress to terminal renal failure even after preparation withdrawal.…”

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confidence: 99%

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Early Renal Failure After Mesalazine (Case Report)

Musil¹,

Tillich²

2000

BIOMED PAP

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An early onset of asymptomatic renal failure in a young man with ulcerative colitis treated with high-dose mesalazine is the subject of this case report. After mesalazine withdrawal, renal function was quickly restored. In contrast with published case reports, the onset of renal impairment occurred very early. Serum urea reached pathological values 27 days and serum creatinine 15 days after mesalazine treatment was started. The diagnosis of renal impairment was supported by urine analysis (both semi-quantitative and quantitative) and dynamic renal isotope scanning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Early Renal Failure After Mesalazine (Case Report)

Musil¹,

Tillich²

2000

BIOMED PAP

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“…Nephrotoxicity has been described in patients with IBD treated with 5-ASA [4,5]. In the literature survey, 5-ASA-associated nephrotoxicity is reported most often within the first 12 months from the initiation of the drug [31], but delayed presentation has also been shown rarely, with the onset of the renal manifestation after several years of the treatment [32,33]. In most of their reports, however, 5-ASA was given continuously during the latent period.…”

Section: Uc Related Interstitial Nephritismentioning

confidence: 99%

Nephritis Associated with Ulcerative Colitis

Tokuyama¹,

Wakino²,

Hayashi³

et al. 2011

Ulcerative Colitis - Epidemiology, Pathogenesis and Complications

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5-Aminosalicylates and renal function in inflammatory bowel disease

Gisbert

González-Lama

Maté

2007

Inflammatory Bowel Diseases

199

144

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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.

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Lesson of the week: Late onset interstitial nephritis associated with mesalazine treatment

Cited by 43 publications

References 8 publications

Early Renal Failure After Mesalazine (Case Report)

Early Renal Failure After Mesalazine (Case Report)

Nephritis Associated with Ulcerative Colitis

5-Aminosalicylates and renal function in inflammatory bowel disease

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