5‐aminosalicylates in inflammatory bowel disease and chronic renal failure
Makaleler > Tam Makale · 2005
Yazarlar: F. Tekin, O. Ozutemiz, T. Ilter
Alimentary Pharmacology & Therapeutics, Uluslararası, Wos, 2005, cilt 22, ss 579-579
DOI: 10.1111/j.1365-2036.2005.02584.x
Özet
Sirs, We read with interest the article by Muller et al.1 on the 5-aminosalicylate (5-ASA) nephrotoxicity in patients with inflammatory bowel disease (IBD). They have estimated that clinical nephrotoxicity occurs in about one in 4000 patients/year taking 5-ASA therapy. Among them, tubulointerstitial nephritis (TIN) was found to be the most common one. In cases with TIN, withdrawal of 5-ASA leads to restoration of renal function in 85% of cases where the diagnosis is made within 10 months of starting treatment, however, further delay in diagnosis is associated with poor outcome.2 Thus, regular monitoring of creatinine level will provide better outcome in these patients. It was recommended that in patients under 5-ASA therapy who had a normal baseline creatinine level, monitoring of renal function should be carried out monthly for the first 3 months, 3-monthly for the next 9 months and annually after 5 years of treatment.3 On the contrary, there exists the lack of data in the literature about the safety of 5-ASA compounds in patients with IBD and chronic renal failure (CRF). In the prospective study by Muller et al., two of 59 patients were known to have pre-existing renal impairment, however, details of these two patients (differences, if any, in dosage of 5-ASA, clinical outcome, etc.) have not been mentioned. We believe that more attention may be needed for patients with CRF and IBD using 5-ASA. Patients with IBD are usually dehydrated during the acute episode because of diarrhoea. In addition, it is well known that patients with CRF are more likely to be affected by prerenal uraemia and nephrotoxic agents. Furthermore, the kidney can be an extraintestinal target of IBD, and CRF can be observed prior to starting 5-ASA therapy4. Thus, we suggest that these circumstances have to be kept in mind when treatment with 5-ASA is started in patients with CRF and IBD.