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Mesalazine-associated interstitial nephritis

M J World1, P E Stevens, M A Ashton

  • 1Royal Army Medical College, Millbank, London, UK.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|April 1, 1996
PubMed
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Oral Asacol (mesalazine) can cause kidney damage (interstitial nephritis) in inflammatory bowel disease patients. Monitor serum creatinine regularly to detect this risk early.

Area of Science:

  • Nephrology
  • Gastroenterology
  • Pharmacology

Background:

  • Oral mesalazine (Asacol) is used for inflammatory bowel disease (IBD).
  • Mesalazine can cause interstitial nephritis, a kidney complication.
  • The exact frequency and detection methods for this complication are unclear.

Observation:

  • This study reviewed 4 new and 12 prior cases of interstitial nephritis linked to oral Asacol.
  • Published clinical trials were analyzed for renal function impairment frequency.
  • Renal impairment may affect up to 1% of patients, with significant nephritis in <0.2%.

Findings:

  • Elevated serum creatinine is the most reliable indicator of Asacol-induced nephrotoxicity.
  • Kidney function may recover if Asacol is withdrawn within 10 months.

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  • Delayed diagnosis (after 18 months) may lead to irreversible renal damage.
  • Immunosuppression offers no significant benefit for late-stage nephrotoxicity.

    • Implications:

    • Regular serum creatinine monitoring is crucial: monthly for 3 months, quarterly for the first year, then annually.
    • Promptly withdraw Asacol if unexplained creatinine elevation occurs.
    • Relying on routine urinalysis or allergy signs is insufficient to rule out interstitial nephritis.