Acute kidney injury in a girl with ulcerative colitis and cytomegalovirus-induced focal segmental glomerular sclerosis

Sankar R. Chirumamilla, Chun He, Lorraine C. Racusen, Ann O. Scheimann, Carmen Cuffari

Baltimore, Maryland, USA

Author Affiliations: Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA (Chirumamilla SR); Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA (He C, Racusen LC); Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, The Johns Hopkins University School of Medicine, Baltimore, MD, USA (Scheimann AO, Cuffari C)

Corresponding Author: Carmen Cuffari, MD, Associate Professor of Pediatrics, The Johns Hopkins University School of Medicine, 600N Wolfe St, Brady 320, Baltimore, MD 21287, USA (Email: ccuffari@jhmi.edu)

doi: 10.1007/s12519-011-0302-8

Background: Mesalamine or 5-aminosalicylic acid (5-ASA) has proven efficacy in treating patients with ulcerative colitis (UC). Although mesalamine is considered safe, it has been associated with acute interstitial nephritis and renal failure.

Methods: Herein we present a case of a child with UC who developed acute renal failure on mesalamine therapy.

Results: A 15-year-old African-American girl with well-controlled UC presented to the Johns Hopkins Hospital with a four-day history of high fever, malaise, generalized body aches, and productive non-bloody cough. Over the next three days, she developed acute renal failure with fluid retention, and elevated serum creatinine and blood urea nitrogen. A kidney biopsy showed drug induced acute interstitial nephritis and focal segmental glomerulosclerosis with viral inclusion bodies likely secondary to cytomegalovirus.

Conclusion: When treating UC patients with a history of underlying renal disease, it is advised to carefully monitor renal function while on mesalamine therapy.

Key words: cytomegalovirus; mesalamine; renal failure; ulcerative colitis

World J Pediatr 2013;9(1):84-86