Table 3. Open in new tab Potential...

Drug

Potential Nephrotoxic Manifestation

Renal Manifestation

5-ASA

Tubulointerstitial nephritis

• Microscopic hematuria, microalbuminuria, sterile pyuria (± eosinophiluria)
• Decrease in eGFR
• Very rare e.g 0.3% per annum¹¹⁴

Calcineurin inhibitors

Acute kidney injury due to tubulointerstitial damage evident as electrolyte disturbances.
Chronic kidney disease due to vasoconstriction/ischaemia leads to interstitial fibrosis

• Hyperkalemia, hypomagnesemia, hyperchloremic metabolic acidosis, hyperuricemia, hyperglycemia
• Microalbuminuria
• Hypertension
• Decrease in eGFR
• Increasing risk with continuous temporal exposure, especially over 5 or more years⁵⁹

TNF-α inhibitors

Acute kidney injury
Glomerulonephritis

• Microalbuminuria/proteinuria
• New onset hypertension
• Decrease in eGFR
• Very rare (but vigilance is prudent)

Vedolizumab

Acute interstitial nephritis

• Dipstick hematuria, microalbuminuria, sterile pyuria (± eosinophiluria)
• Decrease in eGFR
• Very rare (but vigilance is prudent)

Tofacitinib

Acute kidney injury

• Decrease in eGFR
• Very rare (but vigilance is prudent)

Filgotinib

Increased drug concentration in renal impairment so reduce dose

• Monitor eGFR looking for early evidence of loss of renal function

Table 3.

Open in new tab

Potential drug-associated nephrotoxic effects in IBD.

Drug	Potential Nephrotoxic Manifestation	Renal Manifestation
5-ASA	Tubulointerstitial nephritis	• Microscopic hematuria, microalbuminuria, sterile pyuria (± eosinophiluria) • Decrease in eGFR • Very rare e.g 0.3% per annum¹¹⁴
Calcineurin inhibitors	Acute kidney injury due to tubulointerstitial damage evident as electrolyte disturbances. Chronic kidney disease due to vasoconstriction/ischaemia leads to interstitial fibrosis	• Hyperkalemia, hypomagnesemia, hyperchloremic metabolic acidosis, hyperuricemia, hyperglycemia • Microalbuminuria • Hypertension • Decrease in eGFR • Increasing risk with continuous temporal exposure, especially over 5 or more years⁵⁹
TNF-α inhibitors	Acute kidney injury Glomerulonephritis	• Microalbuminuria/proteinuria • New onset hypertension • Decrease in eGFR • Very rare (but vigilance is prudent)
Vedolizumab	Acute interstitial nephritis	• Dipstick hematuria, microalbuminuria, sterile pyuria (± eosinophiluria) • Decrease in eGFR • Very rare (but vigilance is prudent)
Tofacitinib	Acute kidney injury	• Decrease in eGFR • Very rare (but vigilance is prudent)
Filgotinib	Increased drug concentration in renal impairment so reduce dose	• Monitor eGFR looking for early evidence of loss of renal function

Drug	Potential Nephrotoxic Manifestation	Renal Manifestation
5-ASA	Tubulointerstitial nephritis	• Microscopic hematuria, microalbuminuria, sterile pyuria (± eosinophiluria) • Decrease in eGFR • Very rare e.g 0.3% per annum¹¹⁴
Calcineurin inhibitors	Acute kidney injury due to tubulointerstitial damage evident as electrolyte disturbances. Chronic kidney disease due to vasoconstriction/ischaemia leads to interstitial fibrosis	• Hyperkalemia, hypomagnesemia, hyperchloremic metabolic acidosis, hyperuricemia, hyperglycemia • Microalbuminuria • Hypertension • Decrease in eGFR • Increasing risk with continuous temporal exposure, especially over 5 or more years⁵⁹
TNF-α inhibitors	Acute kidney injury Glomerulonephritis	• Microalbuminuria/proteinuria • New onset hypertension • Decrease in eGFR • Very rare (but vigilance is prudent)
Vedolizumab	Acute interstitial nephritis	• Dipstick hematuria, microalbuminuria, sterile pyuria (± eosinophiluria) • Decrease in eGFR • Very rare (but vigilance is prudent)
Tofacitinib	Acute kidney injury	• Decrease in eGFR • Very rare (but vigilance is prudent)
Filgotinib	Increased drug concentration in renal impairment so reduce dose	• Monitor eGFR looking for early evidence of loss of renal function

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