Although treatment with aminosalicylic acid (5-ASA; mesalamine) is frequently recommended for patients with ulcerative colitis and Crohn disease, some cases of nephrotoxicity have been reported.  Baseline assessment and ongoing monitoring of kidney function in these patients is advised, as it has the potential to decrease morbidity and mortality associated with drug nephrotoxicity. These findings are based on the results of a literature review published in Digestive and Liver Disease.

The study authors conducted a search of PubMed, Embase, and Web of Science databases for studies that included monitoring of kidney function during 5-ASA treatment and were published between July and August 2020. The objective of the research was to propose a kidney function monitoring strategy to guide physicians in daily clinical practice.

The researchers found that although several monitoring strategies and guidelines related to kidney function in patients undergoing treatment with 5-ASA have been proposed, the optimum monitoring strategy remains uncertain and clear guidelines are still lacking. The investigators assert that kidney function monitoring should consist of serum creatinine, estimated glomerular filtration rate, and 24-hour proteinuria. They propose that a baseline assessment on all patients treated with 5-ASA should be performed and frequency of monitoring should be determined based on comorbidities, presence of chronic renal disease, and use of nephrotoxic drugs or concomitant steroid therapy.  In the absence of comorbidities, chronic renal disease, and treatment with nephrotoxic drugs or steroids, monitoring should occur every 3 to 4 months during the first year of treatment with 5-ASA, followed by every 3 months thereafter.  Patients with the outlined comorbidities should undergo the aforementioned monitoring every 3 months. 

This study had several limitations including data that were obtained from medical records about prescriptions issued rather than dispensed, and events related to 5-ASA may have been missed.  Also, not all confounding factors were considered, and the exclusion of sporadic or weak nephrotoxic effects of 5-ASA is undetermined.    


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The study authors propose that this kidney function monitoring strategy has the potential to reduce the morbidity and mortality associated with drug nephrotoxicity.  However, additional research and follow-up are warranted to ascertain whether such monitoring can reduce the occurrence of chronic kidney damage and end-stage renal disease related to 5-ASA.   

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Guillo L, D’Amico F, Achit H, et al. Kidney function monitoring to prevent 5-aminosalicylic acid nephrotoxicity: what the gastroenterologist should know. Digestive and Liver Disease. Published online February 6, 2021. doi.org/10.1016/j.dld.2021.01.015