Nephrotic syndrome after treatment with 5-aminosalicylic acid

Novis, Ben; Korzets, Ze’ev; Chen, P; Bernheim, Jan L.

doi:10.1136/bmj.296.6634.1442

Cited by 95 publications

(53 citation statements)

References 4 publications

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“…There is significant delayed absorption in patients with proximal Crohn's disease compared to normal volunteers, and with continued treatment in one patient, absorption returned towards normal. The worry remains that renal toxicity may be a limiting factor of this form of therapy (6)(7)(8)(9). Close monicoring of renal function is an absolute necessity, particularly where long, continued use is contemplated.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacokinetics of 5-Aminosalicylic Acid Enteral Suspension in Crohn's Disease Patients and Normal Volunteers

Williams¹,

Morgan²

1990

Canadian Journal of Gastroenterology

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5-Aminosalicylic acid (5-ASA) is available in many countries in tablet, enema and suppository form. A new enteral suspension was studied in six patients with Crohn's disease affecting the upper gastrointestinal tract and in six healthy volunteers. Four grams of 5-ASA dissolved in 240 ml suspension was given via a nasoduodenal tube over 4 h. Blood was drawn at 0, l, 2, 3, 4, 5, 6, 7, 8, 12 and 24 h, and 24 h urine and stool were collected for 5-ASA and n-acetyl-5-ASA analyses. All patients and subjects tolerated the procedure without problems and no side effects were encountered. All subjects and volunteers had normal renal function before and after the study; serum creatinine and blood urea nitrogen did not change. Urine recovery of 5-ASA ranged from 0.6 to 3.4 g (controls) and 0.46 to 3.6 g (patients). Stool recovery of 5-ASA was 0.1 to 0.3 g (controls) and 0.12 to 0.54 g (patients). There was delayed absorption of 5-ASA in patients compared to controls, shown by time to peak concentrations (4 to 6 h versus 3 h). Predominantly urine excretion of the n-acetyl metabolite occurred in both groups, with less than 12% stool excretion. Continued treatment induced remission. An enteral suspension of 5-ASA may be of benefit in selected patients with proximal small bowel Crohn's disease.

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Section: Discussionmentioning

confidence: 99%

“…It was, therefore, hypothesized that a 5-ASA liquid enema preparation may be suitable for the upper small bowel. The major concern would be increased intestinal absorption and possible renal damage (6)(7)(8). Since the introduction of5-ASA in tablet form, there have been occasional reports of altered serum…”

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confidence: 99%

Pharmacokinetics of 5-Aminosalicylic Acid Enteral Suspension in Crohn's Disease Patients and Normal Volunteers

Williams¹,

Morgan²

1990

Canadian Journal of Gastroenterology

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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%

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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“…However, 5-ASA itself is not adequate to be used for treatment of IBD because it is absorbed rapidly and extensively through the upper intestine before it reaches the colon (Crotty and Jewell 1992). In addition, systemically absorbed 5-ASA is reported to induce nephrotic syndrome (Novis et al 1988). For this reason, 5-ASA is formulated as sustained-release preparations or prodrugs for colon-specific delivery (Chourasia and Jain 2003;Sinha and Kumria 2001).…”

mentioning

confidence: 99%