Kidney function monitoring to prevent 5-aminosalicylic acid nephrotoxicity: What the gastroenterologist should know.

Abstract

BACKGROUND:

The kidney function monitoring is recommended in routine practice to detect 5-aminosalicylic acid (5-ASA) related nephrotoxicity, although is not standardized. The optimal monitoring is unknown, especially the best timing and which tests to perform. We summarized why, how, and when to perform the monitoring for patients treated with 5-ASA and provided an overview of the current guidelines on this topic.

METHOD:

Relevant studies on this topic were searched in PubMed, Embase, and Web of Science databases from July to August 2020.

RESULTS:

Serum creatinine, the estimated glomerular filtration rate, and 24-h proteinuria are the 3 main tests used for the monitoring in daily practice. Regarding the timing, several monitoring strategies have been proposed and guidelines are available too, but they provide conflicting information. To date, there is no medical evidence-based that one strategy is better than another. Comorbidities, chronic renal disease, use of nephrotoxic drugs or concomitant steroid therapy also impact the nephrotoxicity risk. Based on the literature review we proposed a kidney function monitoring strategy to guide physicians in clinical practice.

CONCLUSION:

A baseline assessment should be performed in all patients treated with 5-ASA. The monitoring should be carried out according to the other nephrotoxic factors. A tight monitoring may reduce morbidity and mortality of drug nephrotoxicity.

• Authors: Lucas Guillo, Ferdinando D'Amico, Hamza Achit, Carole Ayav, Francis Guillemin, Silvio Danese, Luc Frimat, Laurent Peyrin-Biroulet
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 53 Issue 6 Pg. 691-696 (Jun 2021) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 33563584 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Mesalamine
• Creatinine

Topics

• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects, pharmacology)
• Colitis, Ulcerative (drug therapy)
• Creatinine (blood)
• Glomerular Filtration Rate (drug effects)
• Mesalamine (administration & dosage, adverse effects, pharmacology)
• Monitoring, Physiologic (methods)
• Proteinuria (blood, chemically induced)
• Renal Insufficiency, Chronic (chemically induced, prevention & control)