Early Renal Failure After Mesalazine (Case Report)

Musil, Dalibor; Tillich, Josef

doi:10.5507/bp.2000.018

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…8,18,52,59,61,63,64,70,71,73,76 -80,93 Other authors have reported only partial improvement of renal function after drug withdrawal. 21,51,[53][54][55][56]68,69,72,74,75,77,81,82 Finally, although most case reports indicate reversibility after cessation of the drug, in some cases permanent clinical kidney dysfunction has been observed. 55,56,58,63,65,69,77,79 Thus, it has been calculated that Ϸ10% of the patients with 5-ASA nephrotoxicity will develop end-stage renal disease.…”

Section: Is Renal Impairment Due To 5-asa Treatment Reversible?mentioning

confidence: 99%

5-Aminosalicylates and renal function in inflammatory bowel disease

Gisbert

González-Lama

Maté

2007

Inflammatory Bowel Diseases

201

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 Mesalazine should be withdrawn when renal impairment manifests in a patient with IBD; if this does not result in a fall in serum creatinine, then renal biopsy should be considered.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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Section: Is Renal Impairment Due To 5-asa Treatment Reversible?mentioning

confidence: 99%

5-Aminosalicylates and renal function in inflammatory bowel disease

Gisbert

González-Lama

Maté

2007

Inflammatory Bowel Diseases

201

144

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“…The onset of renal impairment in IBD patients on 5-ASAs can vary widely, with reports highlighting its onset within 29 days and beyond 5 years 2 10 11. Several studies have confirmed that 50% of cases present within 1 year of treatment initiation 3 12.…”

Section: Introductionmentioning

confidence: 99%

Do gastroenterologists monitor their patients taking 5-amino-salicylates following initiation of treatment

Siddique

Farmer

Muller

2014

Frontline Gastroenterol

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Background5-Amino salicylate (5-ASA) medications may rarely be associated with a significant decline in renal function and interstitial nephritis. British Society of Gastroenterology guidelines advise regular renal function monitoring for patients taking these drugs.AimTo assess whether gastroenterologists in Kent were following best practice guidelines regarding the monitoring of their patients on 5-ASA therapy.MethodsUsing longitudinal community and regional pathology databases for the Kent population, our renal unit regularly screens a total population of 300 000 for evidence of renal disease. The data extracted are analysed using an automated computerised system to identify patients requiring intervention for kidney disease. All patients taking 5-ASA medication were identified from a population of 300 000. The pathology database was studied to identify the patients on 5-ASA treatment and whether they had had renal function tests.Results800 adult patients were identified taking 5-ASA therapy. 612 patients received 5-ASAs for 3 months or more, and these were included in the final analysis. 293 patients had no renal function checks while on treatment. 79 patients had renal function tests less than once every 4 years and 36 patients once every 2–4 years. 204 patients had renal function measurements in 50% or more of years of treatment, of whom 116 were checked every year. Some patients were started on treatment with abnormal results at baseline and some with identified kidney disease continued on their 5-ASAs.ConclusionsThe majority of patients receiving 5-ASA compounds do not have regular renal function monitoring. Clinicians are failing to follow best practice guidelines.

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