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
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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.