Focal Segmental Glomerulosclerosis Secondary to Mesalamine Use in a Patient with Ulcerative Colitis

Abstract

Background:The association between Ulcerative Colitis (UC) and Focal Segmental Glomerulosclerosis (FSGS) is an unexpected condition. Herein we reported a case of FSGS secondary to mesalamine use in a Kuwaiti patient with UC. Case presentation:A 32 years-old man, with a 6-month's history of UC, was admitted with proteinuria and elevated serum creatinine after the use of mesalamine. On March, 2016, there was repeated vomiting, fresh bleeding per rectum for which segmoidoscopy and rectal biopsy done on April, 2016 and revealed UC and mesalamine was started. On October, 2016, the patient started to complain from puffiness of eyelids, LL oedema and headache. There was a positive family history of renal failure. Physical examination, there was hypertension, bilateral mild pitting lower limb oedema. Laboratory investigations demonstrated serum creatinine 143 umol/L and proteinuria 1.9 g/24 h. The old values showed serum creatinine level of 76 umol/L and 24h urine protein level of 140mg/day before starting mesalamine. All immunology and virology tests were negative. Kidney ultrasound was normal, so kidney biopsy was performed and revealed FSGS. The patient treated with prednisolone 30 mg/day, valsartan 160 mg/day with discontinuation of mesalamine. Blood pressure was controlled and kidney function tests and proteinuria improved. Conclusion:Mesalamine use in patients with UC can be associated with FSGS, warranting, the necessary of following the kidney function and proteins in urine while the patients with UC on mesalamine treatment.

Primary focal segmental glomerulosclerosis in a patient with ankylosing spondylitis: A rare presentation requiring a broad differential in nephrotic syndrome

“…There have been case reports of FSGS related to sulfasalazine, but this was not continued during admission and her creatinine continued to rise and her proteinuria persisted, making this medication less likely to be the culprit. 9 Primary FSGS, formerly termed idiopathic FSGS, has been associated with circulating cytokines causing podocyte foot process effacement. 10,11 Primary FSGS is defined by ruling out the likelihood of other forms of FSGS and is presumed to be caused by a yet unidentified podocytetoxic factor and is often amenable to treatment.…”

“…There are no known cases, to our knowledge, of FSGS related to hydrochlorothiazide or adalimumab. There have been case reports of FSGS related to sulfasalazine, but this was not continued during admission and her creatinine continued to rise and her proteinuria persisted, making this medication less likely to be the culprit 9 …”

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