Abstract
Background and aims
Patients with inflammatory bowel diseases (IBD) are exposed to drug-related nephrotoxicity
and kidney-related extra-intestinal manifestations (EIMs). Patients should be monitored
but guidance is lacking in current international recommendations. The objective of
the Kidney Function Monitoring in Inflammatory Bowel Disease (MONITORED) initiative
was to achieve an expert consensus about monitoring kidney function in IBD.
Methods
A literature review was first conducted. Then, an expert consensus meeting, involving
28 attendees representing French-speaking gastroenterologists and nephrologists, was
held as part of an academic initiative on May 28, 2021. An anonymous Delphi process
was used to discuss and vote on statements. Agreement was defined as at least 75%
of participants voting for any one statement.
Results
Experts reached consensus on 11 criteria for referral to the nephrologist. Concerning
kidney function monitoring, participants unanimously validated the use of serum creatinine
with estimation of the glomerular filtration rate via the MDRD or CKD-EPI equations.
A blood ionogram and a urine sample with measurement of a protein-to-creatinine ratio
were also broadly agreed validated. Experts recommended performing this monitoring
at IBD diagnosis, prior introducing a new treatment, and annually for EIMs screening
and evaluation of treatment tolerance. An evaluation 3 months after starting mesalamine
and then every 6 months was felt necessary, while for biologics an annually monitoring
was deemed sufficient.
Conclusion
The MONITORED consensus proposed guidelines on how to monitor kidney function in IBD.
These recommendations should be considered in clinical practice to preserve kidney
function and ensure the best approach to our patients.
Keywords
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References
- Crohn's disease.Lancet Lond Engl. 2017; 389: 1741-1755https://doi.org/10.1016/S0140-6736(16)31711-1
- Ulcerative colitis.Lancet Lond Engl. 2017; 389: 1756-1770https://doi.org/10.1016/S0140-6736(16)32126-2
- Gastroenterologists’ Perceptions Regarding Ulcerative Colitis and Its Management: Results from a Large-Scale Survey.Adv Ther. 2016; 33: 1715-1727https://doi.org/10.1007/s12325-016-0393-7
- Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management.J Crohns Colitis. 2017; 11: 769-784https://doi.org/10.1093/ecco-jcc/jjx009
- Systematic review: short-term adverse effects of 5-aminosalicylic acid agents in the treatment of ulcerative colitis.Aliment Pharmacol Ther. 2004; 19: 179-189https://doi.org/10.1111/j.0269-2813.2004.01827.x
- Review article: interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease.Aliment Pharmacol Ther. 2000; 14: 1-6https://doi.org/10.1046/j.1365-2036.2000.00683.x
- 5-Aminosalicylates and renal function in inflammatory bowel disease: a systematic review.Inflamm Bowel Dis. 2007; 13: 629-638https://doi.org/10.1002/ibd.20099
- Clinical features and HLA association of 5-aminosalicylate (5-ASA)-induced Nephrotoxicity in inflammatory bowel disease.J Crohns Colitis. 2016; 10: 149-158https://doi.org/10.1093/ecco-jcc/jjv219
- Acute renal failure in a 53-year-old woman with Crohn's disease treated with 5-aminosalicylic acid.Am J Kidney Dis Off J Natl Kidney Found. 2001; 38: 205-209https://doi.org/10.1053/ajkd.2001.25216
- Acute interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease.Nephron. 2002; 92: 200-202https://doi.org/10.1159/000064461
- Development of the nephrotic syndrome during treatment of Crohn's disease with adalimumab.J Clin Gastroenterol. 2011; 45: e30-e33https://doi.org/10.1097/MCG.0b013e3181fae913
- Infliximab-Induced Tubulointerstitial Nephritis with Image Findings of Striated Nephrogram in Crohn's Disease.Tohoku J Exp Med. 2018; 245: 149-152https://doi.org/10.1620/tjem.245.149
- Nephrotic syndrome after infliximab treatment in a patient with ulcerative colitis.J Gastrointest Liver Dis JGLD. 2015; 24: 249-251https://doi.org/10.15403/jgld.2014.1121.242.infx
- Interstitial nephritis secondary to vedolizumab treatment in crohn disease and safe rechallenge using steroids: a case report.Am J Kidney Dis Off J Natl Kidney Found. 2018; 71: 142-145https://doi.org/10.1053/j.ajkd.2017.08.008
- Renal manifestations and complications of inflammatory bowel disease.Inflamm Bowel Dis. 2011; 17: 1034-1045https://doi.org/10.1002/ibd.21468
- Extraintestinal manifestations and complications in IBD.Nat Rev Gastroenterol Hepatol. 2013; 10: 585-595https://doi.org/10.1038/nrgastro.2013.117
- Renal Involvement in Inflammatory Bowel Diseases.J Crohns Colitis. 2016; 10: 226-235https://doi.org/10.1093/ecco-jcc/jjv138
- Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management.J Crohns Colitis. 2012; 6: 991-1030https://doi.org/10.1016/j.crohns.2012.09.002
- European evidence-based Consensus on the management of ulcerative colitis: Current management.J Crohns Colitis. 2008; 2: 24-62https://doi.org/10.1016/j.crohns.2007.11.002
- Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee.Am J Gastroenterol. 2010; 105 (quiz 524): 501-523https://doi.org/10.1038/ajg.2009.727
- AGA clinical practice guidelines on the management of mild-to-moderate ulcerative colitis.Gastroenterology. 2019; 156: 748-764https://doi.org/10.1053/j.gastro.2018.12.009
- AGA technical review on the management of mild-to-moderate ulcerative colitis.Gastroenterology. 2019; 156 (e29): 769-808https://doi.org/10.1053/j.gastro.2018.12.008
- Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus.Gastroenterology. 2015; 148 (e3): 1035-1058https://doi.org/10.1053/j.gastro.2015.03.001
- British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.Gut. 2019; 68 (s1-s106)https://doi.org/10.1136/gutjnl-2019-318484
- Safety of treatments for inflammatory bowel disease: clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD).Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2017; 49: 338-358https://doi.org/10.1016/j.dld.2017.01.141
GETAID. Dérivés aminosalicylés : Rowasa®, Fivasa®, Pentasa®, Dipentum®, Salazopyrine®, Quadrasa®. 2019. https://www.getaid.org/fiches-medicament/les-derives-aminosalicyles-rowasa-fivasa-pentasa-dipentum-salazopyrine-quadrasa
- Kidney function monitoring to prevent 5-aminosalicylic acid nephrotoxicity: What the gastroenterologist should know.Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2021; 53: 691-696https://doi.org/10.1016/j.dld.2021.01.015
- KDIGO clinical practice guideline for acute kidney injury.Kidney inter. 2012; 2 (Suppl.): 1-138
- Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Inter. 2013; 3 (Suppl.): 1-150
- CKD: A Call for an Age-Adapted Definition.J Am Soc Nephrol JASN. 2019; 30: 1785-1805https://doi.org/10.1681/ASN.2019030238
Food and Drug Administration. Mesalamine prescribing information as of 05/2010. Accessed August 11, 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/019651s023lbl.pdf
Food and Drug Administration. Mesalamine prescribing information as of 07/2019. Accessed August 11, 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020049s032lbl.pdf
- IgA nephropathy onset in a Crohn's disease patient treated with Adalimumab.Minerva Gastroenterol Dietol. 2016; 62: 223-224
- A case report of nephrotic syndrome due to intake of certolizumab pegol in a patient with Crohn's disease.Am J Gastroenterol. 2010; 105: 234https://doi.org/10.1038/ajg.2009.500
- Acute tubulointerstitial nephritis associated with infliximab in a patient with Crohn's disease.Intern Med Tokyo Jpn. 2016; 55: 1367-1370https://doi.org/10.2169/internalmedicine.55.5834
- Adalimumab-induced IgA nephropathy.BMJ Case Rep. 2019; 12e226442https://doi.org/10.1136/bcr-2018-226442
- No increased risk of nephrotoxicity associated with 5-aminosalicylic acid in IBD: a population-based cohort and nested case-control study.Aliment Pharmacol Ther. 2019; 50: 416-424https://doi.org/10.1111/apt.15408
Article info
Publication history
Published online: December 02, 2021
Accepted:
November 10,
2021
Received:
September 6,
2021
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
