Upper and Lower Limits in the Renal Clearance of Acetylmesalazine in Humans
To investigate upper and lower limits in the renal clearance of acetylmesalazine and mesalazine in humans.
Renal clearance data were obtained from four randomised, crossover bioequivalence studies and one intravenous administration study in 200 healthy volunteers.
Study participants received tablets [gastroresistant single-dose 500mg (n = 24) and prolonged-release, single-dose 1000mg (n = 18); multiple-dose 1000mg three times daily for six days (n = 28)], suppositories [single-dose 500mg (n = 24)] and two intravenous administrations [100 and 250mg mesalazine (n = 6)]. In total 200 drug administrations were carried out, and plasma concentration-time curves and renal excretion rate-time profiles were obtained and analysed. Plasma and urine mesalazine and acetylmesalazine concentrations were determined according to validated methods using HPLC analysis with coulometric or mass spectrometric detection.
The metabolite acetylmesalazine was cleared renally via glomerular filtration and active tubular secretion resulting in renal clearance (CLr) values of 200 to 300 ml/min. The average renal clearance was 210 ml/min, 30% coefficient of variation (CV). Two phases in the upper limit of renal clearance can be distinguished, with renal clearance values of 430 and 340 ml/min, respectively. There was a lower limit of 120 ml/min. The CLr data of mesalazine demonstrated that after the saturable reabsorption process, mesalazine is filtered by the glomerulus, showing an upper limit of 100 ml/min and a lower limit of 1.5 ml/min. Variation in the renal clearance values of mesalazine and its metabolite acetylmesalazine are probably due to variations in cardiac output and hence renal blood flow. Combining the CLr data of mesalazine and acetylmesalazine showed that the saturable tubular reabsorption of mesalazine can also be explained as renal acetylation of mesalazine, resulting in the low CLr of mesalazine and the high CLr of acetylmesalazine.
The renal clearance of the metabolite acetylmesalazine proceeds via glomerular filtration plus active tubular secretion (200 to 300 ml/min). There is an upper (300 to 400 ml/min) and a lower (120 ml/min) limit of renal clearance values, which seem to be governed by physiological variations in the cardiac output. Moreover, saturable renal acetylation of mesalazine may contribute to the overall renal clearance of acetylmesalazine. This finding explains the dosage- and renal supply-dependent renal clearance values of both mesalazine and acetylmesalazine, but will have limited clinical implications as they can be classified as physiological variations. Implications may arise with renal impairment, with slowing down of both renal acetylation of mesalazine and renal excretion of the metabolite acetylmesalazine.
KeywordsRenal Clearance Renal Blood Flow Mesalazine Tubular Reabsorption Pentasa
- 1.Ahnfelt-RHnne I, Nielsen OH, Christensen A, et al. Clinical evidence supporting the radical scavenger mechanism of 5- aminosalicylic acid. Gastroenterology 1990; 98: 1162–9Google Scholar
- 3.Martindale. Reynolds JEF, editor. The extra pharmacopoeia. 31st ed. Gastro-intestinal agents. Mesalazine. London: Pharmaceutical Press, 1996: 1227–8Google Scholar
- 28.Schuster VL, Seldin DW. Renal clearance. In: Seidin DW, Giebisch G, editors. The Kidney, physiology and pathophysiology. 2nded, Volume 1, Raven Press, New York, 1992: 943–78Google Scholar
- 29.Sica DA, Schoolwerth AC. Renal handling of organic anions and cations and renal excretion of uric acid. In: Brenner BM, editor. The Kidney, 5th ed, volume 1, Philadelphia (PA): WB Saunders Company: 1996: 607–26Google Scholar
- 36.Schlant RC, Sonnenblick EH. Normal physiology of the cardiovascular system. In: Schlant RC, Alexander RW, editors. The Heart, arteries and veins, 8th ed, Volume 1, McGraw-Hill, New York: 1994: 113–51Google Scholar
- 41.Fraser JS, Smith D, Lamb E, et al. Prospective study of the effect of 5-aminosalicylic acid (mesalazine) on renal function in inflammatory bowel disease [abstract 4377]. Proceedings Digestive Disease Week 1999 May 16–19, Orlando, Florida, USA, 1999, A-794-5Google Scholar