Elevation in serum creatinine and BUN accompanied by oliguria are usually associated with hypotension, and normalize after treatment with intravenous hydration and steroids. Cases of hematuria secondary to azathioprine-induced crystalluria may be less common with high urine output.
A reduction in the incidence of chronic allograft nephropathy has been reported during the extended follow-up (greater than or equal to 10 years) of patients (n=128) participating in a randomized trial that examined the conversion from cyclosporine to azathioprine (the active ingredient contained in Imuran) as early as three months after renal transplantation.
A 47-year-old female with Wegener's granulomatosis experienced rapid progression of renal failure within 10 days of starting azathioprine for vasculitis. Her creatinine was 119 mcmol/L at the time of presentation. Acute tubulointerstitial nephritis and no active glomerulonephritis were observed on renal biopsy. Her renal function started improving by day 6 post-admission and at one month post-admission her serum creatinine was 116 mcmol/L. She continued to have reasonable renal function and 16 months later had creatinine of 104 mcmol/L with no clinical evidence of recurrent interstitial nephritis. [ Ref ]