The package inserts for products containing 5-aminosalicylic acid, or mesalamine,
include the following language regarding the risk of adverse kidney effects: “renal
impairment, including minimal change nephropathy, acute and chronic interstitial nephritis,
and rarely renal failure, has been reported in patients given products such as mesalamine
delayed-release tablets that contain mesalamine or are converted to mesalamine.” In
this article, we review the data regarding this nephrotoxicity and the recommendations
regarding appropriate monitoring. Chronic interstitial nephritis is a rare occurrence
in patients treated with these drugs for Crohn disease and ulcerative colitis. Patients
often present with asymptomatic reductions in glomerular filtration rate, without
accompanying pyuria, skin lesions, or eosinophilia, unlike cases of acute interstitial
nephritis. Drug cessation is usually associated with improved kidney function. However,
if left undetected, more prolonged exposure to the drug can lead to irreversible kidney
failure and end-stage kidney disease. No convincing studies demonstrate efficacy of
treatment with corticosteroids. Frequent monitoring of serum creatinine, especially
in the first years after initiation of therapy, is recommended.
Key Words
To read this article in full you will need to make a payment
References
-
MESALAMINE – mesalamine tablet, delayed release.
2019 (Available at:)
-
Effects of dialysis on the pharmacokinetics of salazosulfapyridine.
Rheumatol Int. 2013; 33: 535-539
-
Adverse reactions during salicylazosulfapyridine therapy and the relation with drug metabolism and acetylator phenotype.
N Engl J Med. 1973; 289: 491-495
-
Sulphasalazine and mesalazine: serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines.
Gut. 2002; 51: 536-539
-
Clearance of an oral delayed-release mesalazine preparation (Salofalk) by haemodialysis—pharmacokinetic profile of mesalazine related to the effects of dialysis.
Nephrol Dial Transpl. 2000; 15: 736-738
-
Mesalazine: an overview of key preclinical studies.
Scand J Gastroenterol Suppl. 1990; 172: 52-55
-
5-Aminosalicylates and renal function in inflammatory bowel disease: a systematic review.
Inflamm Bowel Dis. 2007; 13: 629-638
-
A case of sulphasalazine-induced DRESS syndrome with delayed acute interstitial nephritis.
Nephrol Dial Transpl. 2009; 24: 2940-2942
-
Mesalamine-induced nephrotoxicity in the treatment of Crohn disease: a case study.
Gastroenterol Nurs. 2014; 37: 70-73
-
The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease.
Clin J Am Soc Nephrol. 2014; 9: 265-270
-
Renal tubular damage: an extraintestinal manifestation of chronic inflammatory bowel disease.
Eur J Gastroenterol Hepatol. 1996; 8: 461-468
-
Renal involvement in inflammatory bowel diseases.
J Crohns Colitis. 2016; 10: 226-235
-
5-aminosalicylic acids and the risk of renal disease: a large British epidemiologic study.
Gastroenterology. 2004; 126: 1733-1739
-
Sulphasalazine and mesalazine: serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines.
Gut. 2003; 52 (Author reply 1530-1531): 1530
-
5-Aminosalicylic acid (5-ASA) and chronic tubulointerstitial nephritis in patients with chronic inflammatory bowel disease: is there a link?.
Nephrol Dial Transpl. 1997; 12: 1839-1841
-
Mesalazine-associated tubulo-interstitial nephritis in inflammatory bowel disease.
Clin Nephrol. 1998; 49: 265-267
-
Clinical features and HLA association of 5-aminosalicylate (5-ASA)-induced nephrotoxicity in inflammatory bowel disease.
J Crohns Colitis. 2016; 10: 149-158
-
Pediatric case of mesalazine-induced interstitial nephritis with literature review.
Pediatr Int. 2013; 55: 385-387
-
Renal tubular dysfunction in patients with inflammatory bowel disease treated with aminosalicylate.
Gut. 1997; 40: 761-766
-
5-Aminosalicylic acid-associated renal tubular acidosis with decreased renal function in Crohn’s disease.
Digestion. 1997; 58: 304-307
-
Nephrotic syndrome after treatment of Crohn’s disease with mesalamine: case report and literature review.
Avicenna J Med. 2012; 2: 9-11
-
Extraintestinal manifestations and complications in inflammatory bowel diseases.
World J Gastroenterol. 2006; 12: 4819-4831
-
Primary chronic interstitial nephritis in Crohn’s disease.
Gastroenterology. 2002; 123: 1436-1440
-
Comparison of relative risks of urinary stone formation after surgery for ulcerative colitis: conventional ileostomy vs. J-pouch. A comparative study.
Dis Colon Rectum. 1996; 39: 50-54
-
Enteric hyperoxaluria: an important cause of end-stage kidney disease.
Nephrol Dial Transpl. 2016; 31: 375-382
-
Uric acid stones and hyperuricosuria.
Adv Chronic Kidney Dis. 2012; 19: 413-418
-
Sulfasalazine-induced crystalluria causing severe acute kidney injury.
Am J Kidney Dis. 2017; 70: 869-873
-
Amyloidosis and inflammatory bowel disease. A 50-year experience with 25 patients.
Medicine (Baltimore). 1992; 71: 261-270
-
Interstitial nephritis in patients with inflammatory bowel disease treated with mesalamine.
J Clin Gastroenterol. 2001; 32: 176-178
-
Granulomatous interstitial nephritis as a manifestation of Crohn disease.
Arch Pathol Lab Med. 2014; 138: 125-127
-
Review article: Interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease.
Aliment Pharmacol Ther. 2000; 14: 1-6
-
Renal effects of long-term treatment with 5-aminosalicylic acid.
Can J Gastroenterol. 2009; 23: 170-176
-
5-aminosalicylic acid inhibits iNOS transcription in human intestinal epithelial cells.
Int J Mol Med. 1999; 4: 437-443
-
The effect of 5-aminosalicylic acid on renal ischemia-reperfusion injury in rats.
Indian J Pharmacol. 2016; 48: 196-199
-
Antioxidant effect of vitamin E and 5-aminosalicylic acid on acrylamide induced kidney injury in rats.
Saudi Med J. 2017; 38: 132-137
-
Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee.
Am J Gastroenterol. 2010; 105 (quiz 524): 501-523
-
The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management.
J Crohns Colitis. 2010; 4: 28-62
-
Guidelines for the management of inflammatory bowel disease in adults.
Gut. 2011; 60: 571-607
Article Info
Footnotes
Financial Disclosure: D.S.G. is an owner of Dr. Arnie’s Inc. and A.A. has no relevant financial interests.
Identification
Copyright
Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.
