‘Lead pipe’ colon (Radiopaedia)
Via email advice line from primary care: This man was diagnosed with interstitial nephritis secondary to mesalazine (prescribed for ulcerative colitis) in 2009. His eGFR has remained stable since and is currently 42. Last year he was started on lisinopril for hypertension, but this was stopped some months later as his BP was too low. The plan then was to reintroduce if BP rose over 130/80 or if proteinuria worsened. Urinary PCR was 15 mg/mmol.
His PCR has increased a little to 20. Blood pressure on his last two visits 123/83, 124/96. I just wanted to check that we should add in lisinopril 2.5mg in vew of this.
I also note that his cholesterol was recently 6.1, LDL 4.2, chol/HDL ratio 4.2. I wonder if we should be starting a statin also? He has no significant family history of heart disease and is an ex-smoker.
Other therapy is azathioprine (only) for ulcerative colitis.
Further information
Looking at results closely, he actually seems to have experienced a small fall in creatinine over the last couple of years .
Write what advice you would give?
Show the renal consultant's reply
That level of proteinuria, just outside the normal range, wouldn’t trigger me in his case. Any threshold is going to be arbitrary, but 50 is sometimes used. Consistently over 50 maybe. His BP is well within limits. His CV risk doesn’t sound sky high, with controlled IBD and moderate CKD (but see Further Info).
Proteinuria is in general a strong marker for progression of renal disease, with higher levels indicating much higher risk. Mostly we are talking about glomerular leaking of protein. He actually had tubulointerstitial disease rather than glomerular, which is associated with lower levels of proteinuria in general, and lower risk of progression if the cause is removed (as it has been for him).
If he showed any signs of long term deterioration I’d be stricter.
Further info
Case contributed by Neil Turner
Last Updated on July 17, 2025 by admin
