From the Guidelines
Azathioprine (Azoran) can cause renal side effects, and patients with renal impairment may require dose reduction, careful monitoring of kidney function, and possible adjustments to minimize risks. The British National Formulary advises that dose reduction may be needed in renal impairment, although controlled studies do not show enhanced toxicity in the presence of renal insufficiency 1. Patients taking azathioprine should be monitored for signs of renal impairment, including decreased urine output, fluid retention, and elevated creatinine levels. Regular monitoring of kidney function through blood tests (BUN, creatinine) and urinalysis is essential, particularly during the initial months of treatment or after dose adjustments.
Some key points to consider when prescribing azathioprine to patients with renal impairment include:
- Dose reduction may be necessary to minimize the risk of renal toxicity
- Careful monitoring of kidney function is essential to detect any signs of renal impairment
- Patients with pre-existing kidney disease require especially careful monitoring and possibly dose adjustments
- Adequate hydration while taking azathioprine can help minimize some renal risks
- If kidney function deteriorates while on azathioprine, the medication may need to be discontinued or the dose reduced under medical supervision.
It is also important to note that azathioprine can be used in patients undergoing haemodialysis, and the dosage does not need to be altered in these cases 1. However, the dosage should be at the lower end of the normal range, and patients should be carefully monitored for signs of haematological toxicity.
In terms of treatment guidelines, the European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommend that azathioprine may be considered as an alternative to mycophenolic acid or cyclophosphamide in selected patients without adverse prognostic factors 1. However, azathioprine use is associated with a higher flare risk, and patients should be carefully monitored for signs of disease activity.
Overall, azathioprine can be a effective treatment option for patients with certain medical conditions, but it is essential to carefully monitor patients for signs of renal impairment and adjust the dosage as needed to minimize risks.
From the FDA Drug Label
It is suggested that patients on AZASAN have complete blood counts, including platelet counts, weekly during the first month, twice monthly for the second and third months of treatment, then monthly or more frequently if dosage alterations or other therapy changes are necessary. Delayed hematologic suppression may occur In patients with severe myelosuppression, consider evaluation for TPMT and NUDT15 deficiency Limited immunologic and other abnormalities have occurred in a few infants born of renal allograft recipients on AZASAN.
The FDA drug label does not answer the question about Azoran side effects on renal. 2
From the Research
Azoran Side Effects on Renal Function
- The studies 3, 4, 5 suggest that switching from azathioprine to mycophenolate mofetil and reducing cyclosporine dosage can improve renal function in heart transplant recipients with cyclosporine-induced nephrotoxicity.
- The improvement in renal function is evidenced by lower serum creatinine, urea nitrogen, uric acid, and higher creatinine clearance 3, 4, 5.
- Azathioprine was discontinued and cyclosporine was tapered in these studies, which may have contributed to the improvement in renal function 3, 4, 5.
- The long-term benefits of therapy with low doses of cyclosporine plus mycophenolate mofetil in heart transplant patients with drug-induced nephrotoxicity were studied, and the results showed a significant improvement in renal function 4.
- Another study compared the efficacy of mycophenolate mofetil and azathioprine in the maintenance therapy of lupus nephritis, and found that both drugs were effective in reducing proteinuria and improving renal function 6.
Comparison of Azathioprine and Mycophenolate Mofetil
- The studies suggest that mycophenolate mofetil may be more effective than azathioprine in improving renal function in certain patient populations 3, 4, 5.
- However, another study found that both mycophenolate mofetil and azathioprine were effective in maintaining renal function in patients with lupus nephritis, with no significant difference between the two groups 6.
- The choice between azathioprine and mycophenolate mofetil may depend on individual patient factors and the specific clinical context 3, 4, 5, 6.
Renal Function Outcomes
- The studies reported improvements in renal function outcomes, including: