Acute tubular injury associated with mesalazine therapy in an adolescent girl with inflammatory bowel disease.
Mesalazine is a first-line drug in pediatric inflammatory bowel disease, and is effective as primary treatment and maintenance therapy. It's usually well tolerated, but various side effects have been described. A 15-year-old female with ulcerative colitis developed polyuria, polydipsia, vomiting, and fatigue. She was receiving mesalazine (500 mg, thrice daily, p.o.) and prednisolone for 4 months. She was detected as acute tubular injury as she had dehydration, acidosis, hypostenuria, hematuria, proteinuria, low levels of potassium, uric acid and bicarbonate. These findings were attributed to interstitial nephritis as a side effect of mesalazine, however as renal biopsy was disapproved by the parents, it was not confirmed. After discontinuation of mesalazine her renal tubular functions improved. Potassium and phosphorus supplements were stopped after 7 months, although she had to continue bicarbonate supplementation. We conclude that regular renal screening is important in patients receiving 5-ASA therapy to prevent rare but serious complications, such as interstitial nephritis sometimes leading to chronic renal failure.
Uslu
Nuray
N
Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey. nurayu@hacettepe.edu.tr
Demir
Hulya
H
Saltik-Temizel
Inci Nur
IN
Topaloğlu
Rezan
R
Gürakan
Figen
F
Yüce
Aysel
A
D000208:Acute Disease; D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D019804:Mesalamine / Q000009:adverse effects* / Q000627:therapeutic use; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014463:Ultrasonography
D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine