5-ASA therapy and renal function in inflammatory bowel disease

Mesalazine induced focal segmental glomerulosclerosis in a patient with ulcerative colitis

Focal segmental glomerulosclerosis (FSGS) and other glomerulonephritis due to the use of 5-aminosalicylic acid derivatives have been reported in the literature. A 38-year-old male who had been using mesalazine for four years because of ulcerative colitis applied to doctor due to swelling in the lower extremities. The patient was diagnosed with nephrotic syndrome (NS). Renal biopsy was performed, and FSGS was diagnosed. Antiproteinuric treatments were initiated with steroid therapy. The patient has been followed with the normal renal function of the after treatment. 5-aminosalicylic acid derivatives affect renal functions at different levels and caused in NS.

Inhibitory effect of Jangkanghwan (Korean traditional food) on experimental ulcerative colitis in mice

Jangkanghwan (JKH) can delay weight loss in mice, promote weight gain during recovery, and reduce colonic shortening and colon weight. In addition, the murine disease activity index was controlled after treatment using JKH. It can reduce the content of pro-inflammatory factors in serum and expression in tissues, such as interleukin (IL)-6, IL-1β, tumor necrosis factor-α, interferon-γ, cyclooxygenase-2, and nuclear factor kappa-B; in contrast, the content and expression of IL-10 and the inhibitor of nuclear factor kappa-B kinase-α in the serum and tissues were increased. The mRNA expression of the colitis characteristic biomarker monocyte chemoattractant protein-1 and macrophage inflammatory protein-3α were reduced in colon tissues. Using next-generation sequencing technology, the Bacteroidetes phylum in the JKH group decreased, while the Firmicutes phylum increased, and the number of beneficial bacteria-Bifidobacteriaceae, Lactobacillaceae, and Akkermansiaceae-increased. PRACTICAL APPLICATIONS: JKH is a mixture of colonic healthy foods composed of Atractylodes macrocephala koidzumi, radish leaves, Viscum album var. coloratum, dried Zingiber officinale Roscoe, etc. According to UPLC-Q-TOF MS analysis, JKH consists mainly of 17 active substances, such as pheophorbide A, nabumetone alcohol, dehydrocostus lactone, plantamajoside, kaempferol 3, 7-dirhamnoside, quercetin 3-D-glucuronide, and viscumneoside III. We investigated the preventive effects of JKH on dextran sulfate sodium (DSS)-induced ulcerative colitis in a murine model and found that JKH can reduce the damage in mice caused by DSS treatment.

Effect of 5-aminosalicylates on renal function in patients with inflammatory bowel disease: 4-year follow-up study

OBJECTIVE

Nephrotoxicity has been described in some patients with inflammatory bowel disease (IBD) treated with 5-aminosalicylates (5-ASA). Our aim was to conduct a retrospective study of IBD patients, both with and without 5-ASA treatment, who underwent regular evaluation of renal function over a 4-year period.

METHODS

Serum creatinine was measured before the start of 5-ASA therapy, and thereafter yearly up to 4 years. Creatinine clearance (Cl(Cr)) was estimated from serum creatinine (Cockroft and Gault formula). The influence of 5-ASA treatment on renal function was assessed by univariate and multivariate analysis.

RESULTS

A total of 150 IBD patients (ulcerative colitis in 45%, Crohn's disease in 55%) were included. Sixty-two patients were receiving 5-ASAs (95% coated mesalazine, mean dose 1.9 +/- 0.8 g/day). Both serum creatinine levels and ClCr were similar in patients with and without 5-ASA treatment, and remained stable throughout the 4-year follow-up in patients taking 5-ASAs. In the multivariate analysis, 5-ASA treatment (or its dose) was not correlated with serum creatinine levels or Cl(Cr). No interstitial nephritis was reported during follow-up.

CONCLUSION

5-ASA-related renal disease was not found in our series, suggesting that the occurrence of renal impairment in IBD patients receiving these drugs is exceptional. Our results do not support the recommendation of serum creatinine monitoring in patients receiving 5-ASA treatment.

5-Aminosalicylates and renal function in inflammatory bowel disease: a systematic review

Nephrotoxicity has been described in some patients with inflammatory bowel disease (IBD) treated with 5-aminosalicylic acid (5-ASA). Studies with 5-ASA treatment in which serum creatinine or creatinine clearance was measured regularly show that nephrotoxicity is exceptional (mean rate of only 0.26% per patient-year). There have been several case reports, including 46 patients, of renal disease associated with 5-ASA treatment in patients with IBD. 5-ASA treatment-related nephrotoxicity is reported most often within the first 12 months, but also delayed presentation after several years has been shown. The absence of a clear relationship between 5-ASA dose and the risk of nephrotoxicity suggests that this complication is idiosyncratic rather than dose-related. Most of the patients with renal disease associated with 5-ASA treatment suffered interstitial nephritis, with symptoms and signs being nonspecific, which may delay detection for many months. The nephrotoxicity potential of mesalazine and sulfasalazine seems to be similar. The risk with different oral preparations of 5-ASA is probably too small to influence the choice of agent. Mesalazine should be withdrawn when renal impairment manifests in a patient with IBD; if this does not result in a fall in serum creatinine, then renal biopsy should be considered. A trial of high-dose steroid may be recommended in patients whose renal function does not respond to drug withdrawal. The optimal monitoring schedule of serum creatinine in patients receiving 5-ASA treatment remains to be established, as there is no evidence to date that either the test, or the frequency of testing, improves patient outcomes.