Question on lab results

[Guest guest]

Hi Everyone,

My gastro ordered some labwork last week and I went and picked up a

copy of the results today. I was wondering if anyone could answer a

question about the glomerular filtration rate. I know it has to do

with kidney function from a quick internet search. Is it one of those

lab results that tend to vary with PSC? My report says mine is 45

mL/min/1.73 squared. There is a box on the report that says the

population mean for my age is 107 mL/min/1.73 and that less than 60

mL/min/1.73 square meters is indicative of chronic kidney disease.

If this is one of those lab results that can vary with PSC then I'm

happy to ignore it. If its something to investigate then I guess I'll

have to make sure my primary care dr got the labwork from the gastro

and make an appt. Any advice would be appreciated.

Thanks,

Darcy

PSC 2007

[Guest guest]

Hi Darcy;

If you have ulcerative colitis and are taking a 5-aminosalicylate,

such as asacol or mesalamine (mesalazine), then there is a small risk

of developing kidney disease (tubulo-interstitial nephritis) as an

adverse effect of this medication:

Aliment Pharmacol Ther. 2000 Jan;14(1):1-6.

Review article: interstitial nephritis associated with the use of

mesalazine in inflammatory bowel disease.

Corrigan G, s PE

Kent and Canterbury Hospital, Canterbury, UK.

5-Aminosalicylic acid (5-ASA) has replaced sulphasalazine as first

line therapy for mild to moderately active inflammatory bowel disease

and is widely used. A number of reports have linked oral 5-ASA

therapy to chronic tubulo-interstitial nephritis and this

relationship is now well established. Despite increasing recognition

of the potential for this serious adverse event, guidelines for

monitoring renal function in patients prescribed 5-ASA preparations

are not widely employed. Whilst the incidence of this adverse event

in the population of patients with inflammatory bowel disease treated

with mesalazine is low, the morbidity in an affected individual is

high with some cases progressing to end-stage renal disease. Routine

monitoring of renal function is simple and inexpensive and could

prevent this outcome. Based on the available data, serum creatinine

should be estimated prior to commencing treatment, monthly for the

first 3 months, 3-monthly for the next 9 months, 6-monthly thereafter

and annually after 5 years of treatment. PMID: 10632639.

The full text of the above article is available at:

http://www3.interscience.wiley.com/cgi-bin/fulltext/120708742/PDFSTART

see also:

Aliment Pharmacol Ther. 2005 May 15;21(10):1217-24.

Experience of 5-aminosalicylate nephrotoxicity in the United Kingdom.

Muller AF, s PE, McIntyre AS, Ellison H, Logan RF

Department of Medicine, The Kent and Canterbury Hospital, Canterbury,

Kent, UK. andrew.muller@...

AIM: To study 5-aminosalicylate nephrotoxicity in patients with

inflammatory bowel disease in the UK. METHODS: A detailed postal

questionnaire was sent to all 1298 names in the British Society of

Gastroenterology database and 290 consultant members of the Renal

Association. The British Society of Gastroenterology reported new

cases monthly, the Renal Association 6 monthly. Results were

expressed as estimated glomerular filtration rate. RESULTS:

Retrospective study: cases--British Society of Gastroenterology:Renal

Association 202:87, aged 15-76 years. Median peak (range) creatinine

(British Society of Gastroenterology:Renal Association) - 300:301 (78-

1200) micromol/L. Prospective study - 59 cases, median age 52 years

(M:F ratio: 47:12). Median pre-treatment estimated glomerular

filtration rate: 76.9 (123.9-39), at diagnosis 28.4 (80.5-3.6,

creatinine range: 92-1361 micromol/L), recovery 46.8 [111.2-end stage

renal failure] mL/min/1.73 m2. Recovery of renal function was

significantly improved for patients treated for < 12 months [n = 10,

median recovery estimated glomerular filtration rate 70.5 (92-26.9)

vs. > 12 months 38.4 (111.2-end stage renal failure) mL/min/1.73 m2,

P = 0.028]. CONCLUSIONS: Regular monitoring of renal function may

allow earlier detection of nephrotoxicity, particularly during the

first year of therapy. Based on an inflammatory bowel disease

prevalence in the United Kingdom of 412 x 10(5) with about 50% on

treatment, we estimate that the incidence of clinical nephrotoxicity

in patients taking 5-aminosalicylate therapy is approximately one in

4000 patients/year. PMID: 15882242.

The full text of the above article is available at:

http://www3.interscience.wiley.com/cgi-bin/fulltext/118696403/PDFSTART

So, if you are taking asacol for ulcerative colitis associated with

PSC, this might might be a potential cause to consider.

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Hi Darcy;

If you have ulcerative colitis and are taking a 5-aminosalicylate,

such as asacol or mesalamine (mesalazine), then there is a small risk

of developing kidney disease (tubulo-interstitial nephritis) as an

adverse effect of this medication:

Aliment Pharmacol Ther. 2000 Jan;14(1):1-6.

Review article: interstitial nephritis associated with the use of

mesalazine in inflammatory bowel disease.

Corrigan G, s PE

Kent and Canterbury Hospital, Canterbury, UK.

5-Aminosalicylic acid (5-ASA) has replaced sulphasalazine as first

line therapy for mild to moderately active inflammatory bowel disease

and is widely used. A number of reports have linked oral 5-ASA

therapy to chronic tubulo-interstitial nephritis and this

relationship is now well established. Despite increasing recognition

of the potential for this serious adverse event, guidelines for

monitoring renal function in patients prescribed 5-ASA preparations

are not widely employed. Whilst the incidence of this adverse event

in the population of patients with inflammatory bowel disease treated

with mesalazine is low, the morbidity in an affected individual is

high with some cases progressing to end-stage renal disease. Routine

monitoring of renal function is simple and inexpensive and could

prevent this outcome. Based on the available data, serum creatinine

should be estimated prior to commencing treatment, monthly for the

first 3 months, 3-monthly for the next 9 months, 6-monthly thereafter

and annually after 5 years of treatment. PMID: 10632639.

The full text of the above article is available at:

http://www3.interscience.wiley.com/cgi-bin/fulltext/120708742/PDFSTART

see also:

Aliment Pharmacol Ther. 2005 May 15;21(10):1217-24.

Experience of 5-aminosalicylate nephrotoxicity in the United Kingdom.

Muller AF, s PE, McIntyre AS, Ellison H, Logan RF

Department of Medicine, The Kent and Canterbury Hospital, Canterbury,

Kent, UK. andrew.muller@...

AIM: To study 5-aminosalicylate nephrotoxicity in patients with

inflammatory bowel disease in the UK. METHODS: A detailed postal

questionnaire was sent to all 1298 names in the British Society of

Gastroenterology database and 290 consultant members of the Renal

Association. The British Society of Gastroenterology reported new

cases monthly, the Renal Association 6 monthly. Results were

expressed as estimated glomerular filtration rate. RESULTS:

Retrospective study: cases--British Society of Gastroenterology:Renal

Association 202:87, aged 15-76 years. Median peak (range) creatinine

(British Society of Gastroenterology:Renal Association) - 300:301 (78-

1200) micromol/L. Prospective study - 59 cases, median age 52 years

(M:F ratio: 47:12). Median pre-treatment estimated glomerular

filtration rate: 76.9 (123.9-39), at diagnosis 28.4 (80.5-3.6,

creatinine range: 92-1361 micromol/L), recovery 46.8 [111.2-end stage

renal failure] mL/min/1.73 m2. Recovery of renal function was

significantly improved for patients treated for < 12 months [n = 10,

median recovery estimated glomerular filtration rate 70.5 (92-26.9)

vs. > 12 months 38.4 (111.2-end stage renal failure) mL/min/1.73 m2,

P = 0.028]. CONCLUSIONS: Regular monitoring of renal function may

allow earlier detection of nephrotoxicity, particularly during the

first year of therapy. Based on an inflammatory bowel disease

prevalence in the United Kingdom of 412 x 10(5) with about 50% on

treatment, we estimate that the incidence of clinical nephrotoxicity

in patients taking 5-aminosalicylate therapy is approximately one in

4000 patients/year. PMID: 15882242.

The full text of the above article is available at:

http://www3.interscience.wiley.com/cgi-bin/fulltext/118696403/PDFSTART

So, if you are taking asacol for ulcerative colitis associated with

PSC, this might might be a potential cause to consider.

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Thanks to everyone for your replies!!

I don't have UC and haven't had any medication changes other than adding antibiotics everyday but that was done after the labs were drawn. My creatinine level is also elevated along with the low GFR. I'm guessing that I should probably call my family dr. I'm just dragging my feet because I wanted to be doctor-free for the rest of 2008.

Thanks again,

Darcy