Mesalazine Use in Kidney Failure
Mesalazine should be used with caution in patients with impaired renal function, with careful monitoring of renal function before initiation and periodically during treatment. Discontinue mesalazine if renal function deteriorates while on therapy. 1
Renal Considerations with Mesalazine
- Mesalazine is substantially excreted by the kidneys, increasing the risk of toxic reactions in patients with impaired renal function 1
- Renal impairment, including minimal change nephropathy, acute and chronic interstitial nephritis, and rarely renal failure, has been reported in patients taking mesalazine 2
- The nephrotoxicity associated with mesalazine appears to be idiosyncratic rather than dose-related, as there is no clear relationship between dose and risk 3
Monitoring Recommendations
- Evaluate renal function in all patients prior to initiation of mesalazine therapy 1
- Monitor renal function periodically during treatment, especially in the first year 1, 4
- Some experts recommend monitoring every 6 months due to the risk of rapid progression to end-stage renal disease 5
- Pay particular attention to patients with:
- Known renal impairment
- History of renal disease
- Concurrent use of nephrotoxic drugs 1
Clinical Presentation of Mesalazine-Induced Nephrotoxicity
- Most cases present within the first 12 months of treatment, but delayed presentation after several years has been reported 3
- Symptoms are often nonspecific, which may delay detection 3
- Clinical manifestations may include:
- Asymptomatic reductions in glomerular filtration rate
- Fever and arthralgia in some cases
- Possible eosinophilia 6
- Interstitial nephritis is the most common pathological finding 3, 6
Management of Patients with Renal Impairment
- If renal function deteriorates while on mesalazine therapy, discontinue the medication 1
- If renal function does not improve after drug withdrawal, consider renal biopsy 3
- A trial of high-dose steroids may be beneficial in patients whose renal function does not respond to drug withdrawal 3, 6
- Early discontinuation of mesalazine is associated with better recovery of renal function 6
Common Pitfalls to Avoid
- Failing to monitor renal function regularly, especially in the first year of treatment 4
- Delaying discontinuation of mesalazine when renal impairment is detected 6
- Overlooking the possibility of mesalazine-induced nephrotoxicity when renal function declines in patients with inflammatory bowel disease 4
- Assuming that normal renal function at one assessment guarantees safety for extended periods—cases of end-stage renal disease have developed within 10 months of normal creatinine readings 5
While mesalazine remains an important treatment for inflammatory bowel disease, its potential nephrotoxicity requires vigilance, especially in patients with pre-existing renal impairment or risk factors for kidney disease.