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Pediatric case of mesalazine-induced interstitial nephritis with literature review

Maridine L Co1, Emmanuel C Gorospe

  • 1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA. mco@dmc.org

Pediatrics International : Official Journal of the Japan Pediatric Society
|June 21, 2013
PubMed

Insights

Mesalazine can cause interstitial nephritis (M-IIN) in pediatric patients with ulcerative colitis. Early detection through serum creatinine monitoring is crucial for timely treatment and improved kidney function.

Area of Science:

  • Pediatric Nephrology
  • Gastroenterology
  • Drug-Induced Kidney Injury

Background:

  • Ulcerative colitis (UC) is a chronic inflammatory bowel disease often treated with mesalazine.
  • Mesalazine-induced interstitial nephritis (M-IIN) is a rare but serious adverse effect.
  • Pediatric cases of M-IIN are infrequently reported, necessitating further investigation.

Observation:

  • A 14-year-old boy with UC developed M-IIN.
  • Renal function improved after discontinuing mesalazine and initiating corticosteroid therapy.
  • A literature review identified eight pediatric cases of M-IIN, predominantly in boys with UC.

Findings:

  • The average duration of mesalazine use before M-IIN diagnosis was 24 months (±18 months) at a median dose of 1.5 g/day.
  • M-IIN appears to be an idiosyncratic reaction, unrelated to mesalazine dose or duration.
  • No routine renal function surveillance guidelines exist for mesalazine therapy.

Implications:

  • Monitoring serum creatinine is a cost-effective, non-invasive method for early M-IIN detection in pediatric patients.
  • Prompt diagnosis and treatment of M-IIN can lead to improved renal outcomes.
  • Further research into M-IIN pathogenesis and optimal monitoring strategies is warranted.

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