The role of the clinical laboratory in the study of mesalazine-induced nephrolithiasis and crystalluria

Abstract

Objectives: The development of urinary lithiasis is a relatively frequent complication in patients with inflammatory bowel disease (IBD). A multiplicity of factors-including medication-may induce the formation of renal stones and cause complications of variable severity. Case presentation: We report a six-case series of patients with IBD treated with mesalazine who developed renoureteral colic. Spontaneous stone expulsion occurred in three patients, with infrared spectroscopy (IRS) confirming a composition of 100 % mesalazine. In the other three cases, the presence of crystalluria was confirmed in urine sediment during the renal colic. In two of these patients, IRS analysis of dried urine sediment confirmed a mesalazine composition. Conclusions: The scarce literature available on the association between the use of mesalazine and increased risk of lithiasis fails to provide frequency data. Only a previous case on mesalazine crystalluria had been reported in the literature so far, probably due to the difficulty detecting this complication. This case series emphasizes the role of urine sediment analysis in identifying crystalluria and preventing major complications during the follow-up of patients receiving mesalazine therapy.