Renal impairment aminosalicylates

Eiseviers MM, D Haens G, Lerebours E, Plane C, Stolear JC, Riegler G, Capasso G, Van Outryve M, Mishevska-Mukaetova P, Djuranovic S, Peickmans P, De Broe ME, forthe 5-ASA study group. Renal impairment in patients with inflammatory bowel disease association with aminosalicylate therapy Clin Nephrol 2004 61 (2) 83-91. 

Observational studies Mesalazine (mesala-mine, 5-aminosalicylic acid) has been linked with tubulointerstitial nephritis in patients with inflammatory bowel disease. In a retrospective analysis of renal impairment during long-term use of aminosalicylates in 171 patients with inflammatory bowel disease, the mean daily dose was 3.65 g/day and the mean treatment duration 8.4 years treatments included mesalazine (74%), sulfasalazine (15%), and the combination (11%) [87 ]. Serum creatinine concentrations increased significantly during treatment, from 77 to 89 pmol/1, and creatinine clearance fell significantly from 105 to 93 ml/minute. The fall in creatinine clearance correlated positively with the mean daily dose. There was one case of interstitial nephritis. 

Renal function impairment Patients with severe renal disease will accumulate aminosalicylic acid and its acetyl metabolite but will continue to acetylate, thus leading exclusively to the inactive acetylated form deacetylation, if any, is not significant. Patients with end-stage renal disease should not receive aminosalicylic acid. 

Test results are affected by defective intestinal absorption caused by intestinal disease or variations in transit time, by impaired hepatic conjugation caused by liver disease, and by impaired renal excretion. To compensate for these possible errors, a control substance (e.g., PABA) may be given on a second day, or alternatively, C-PABA or p-aminosalicylic acid (PAS) can be given orally with the NBT-PABA. Low recovery of the control substance in the urine indicates probable decreased intestinal absorption or decreased renal excretion. About 60% (range 48% to 72%) of the orally administered dose is recovered in the urine normally. In pancreatic insufficiency, PABA excretion is significantly decreased. The result is then calculated as a pancreatic excretion index (PEI) as follows ... 

THERAPEUTIC USES Ethambutol (myambutol) has been used with notable success in the therapy of tuberculosis when given concurrently with isoniazid and largely has replaced aminosalicylic acid. Ethambutol is available for oral administration in tablets. The usual adult dose is 15 mg/kg given once a day. Some clinicians use 25 mg/kg/day for the first 60 days, followed by 15 mg/kg/day, particularly for those treated previously. Dose adjustment is necessary in patients with impaired renal function. Ethambutol is not recommended for children under 5 years of age because of concern about the ability to test their visual acuity. Children from ages 6-12 years should receive 10-15 mg/kg/day. 

---

See also in sourсe #XX -- [ ]

---