Mesalazine
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Nephrolithiasis: 2 case reports In a case series, two women aged 40 years and 39 years were described who developed nephrolithiasis following treatment with mesalazine for ulcerative proctitis or Crohn’s disease [time to reaction onsets and outcomes not stated]. Both cases were reported to the Spanish Pharmacovigilance System (case 1 notification number: NR7906 and case 2 notification number: NR9255). Case report 1: A 40-year-old woman was diagnosed with ulcerative proctitis in January 2001. She started receiving oral mesalazine [Pentasa] 4g/24 hours and rectal suppositories of mesalazine 1g/24 hours in case of exacerbation. Her concurrent medication was azathioprine. However, at the end of 2018, she started experiencing recurrent renal colic accompanied by intense voiding symptoms with expulsion of small orange lithiasis with a soft texture. The lithiasis were analysed by conventional method without any conclusive results. An abdominopelvic CT without contrast revealed non-obstructive punctate lithiasis of 2mm located in the lower pole of the right kidney. One year later, she presented to the emergency department with pain in the right upper hypochondrium and dysuria persisting for several hours. Laboratory investigation revealed mild anaemia and haematuria (urinary sediment of 100-200 RBC per field). A new, fragmeted lithiasis sample with smooth, yellowish surface and scant consistency was analysed by infrared spectroscopy and was identified as mesalazine. She continued mesalazine therapy at a reduced dose and with plenty of hydration. As per adverse reaction attribution algorithm, association between nephrolithiasis and mesalazine was classified as probable. Case report 2: A 39-year-old woman was diagnosed with Crohn’s disease in 2015. She started receiving oral mesalazine [Pentasa] 4g/24 hours and rectal mesalazine foam 1g/72 hours. However, in May 2018, she presented with abdominal pain located in the hypogastrium and right renal fossa, associated with dysuria and dark urine with small grains. She was hospitalised. Abdominal ultrasound and urinary sediment was found to be normal. Therefore, she was discharged. In March 2020, she presented to the emergency department with pain in the iliac fossa and expulsion of a calculus at home with an irregular appearance, rough surface, beige colour and scant consistency. Biochemical evaluation revealed haematuria (urinary sediment of 100-200 RBC per field) and desquamation of the cells of the epithelium. The calculus was analysed by infrared spectroscopy and was identified as mesalazine. Her condition improved and she continued mesalazine therapy at a reduced dose of 2g/24 hours. As per adverse reaction attribution algorithm, association between nephrolithiasis and mesalazine was classified as probable. Rodriguez AV, et al. Mesalazine renal lithiasis. [Spanish]. Archivos Espanoles de Urologia 73: 561-564, No. 6, Jul 2020. Available from: URL: https://aeurologia.com/ 803497175 article_detail.php?aid=2c97bf2fe012450069b12c565dc9d72d72281b1a [Spanish; summarised from a
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