Dr Sadia Jahan1, Dr Alan Xu1, Dr Rhea Danner1, Dr Imogen Sellars1, Prof Toby P Coates1
1CNARTS, Adelaide, Australia
Background
A plethora of case reports are published around the relationship between acute interstitial nephritis (AIN) and irritable bowel disease (IBD) management medications. A well-established relationship exists between Vedolizumab and AIN. There are also reports of Mesalazine and AIN, which could manifest months to years post treatment. We present a case of AIN and the causative drug under contention.
Case Report
We present a case of a 19-year-old female with a history of ulcerative colitis for 1 year which was managed with Mesalazine since the initial diagnosis and trialled on Azathioprine and Infliximab will nil effect. She was commenced on Vedolizumab in February and bloods prior to this showed creatinine 60umol/L. 2 months post the first infusion of Vedolizumab, she presented with calf pain and routine bloods showed creatinine 280umol/L. Urine dip showed blood and protein and a renal biopsy was consistent with florid acute interstitial nephritis. As Vedolizumab was the most recent addition to her medications, the initial blame was on this. However, her treating gastroenterologist connected Mesalazine to the AIN and hence this has been ceased together with commencement of high dose steroids. All these measures have improved creatinine to 160umol/L, but not back to baseline. The potential for AIN from Vedolizumab persists.
Conclusions
This case highlights the importance of careful history, especially medication history to work out the potential causative drugs for AIN. Our patient was on both Mesalazine and Vedolizumab, and potentially both are the reason behind her sudden acute kidney injury.
Biography:
Bio to come