Inflammatory Bowel Diseases

Skip Navigation LinksHome > January 2014 - Volume 20 - Issue 1 > Prednisolone but Not Infliximab Aggravates the Upregulated H...
Inflammatory Bowel Diseases:
doi: 10.1097/01.MIB.0000437496.07181.4c
Original Clinical Articles

Prednisolone but Not Infliximab Aggravates the Upregulated Hepatic Nitrogen Elimination in Patients with Active Inflammatory Bowel Disease

Thomsen, Karen L. MD, PhD*; Grønbæk, Henning MD, PhD*; Dahlerup, Jens F. MD, DMSc*; Aagaard, Niels K. MD, PhD*; Christensen, Lisbet A. MD, DMSc*; Agnholt, Jørgen MD, PhD*; Frystyk, Jan MD, DMSc; Vilstrup, Hendrik MD, DSc*

Collapse Box


Background: Catabolism and weight loss are serious problems in patients with active inflammatory bowel disease (IBD). The body nitrogen (N) depletion is partly related to increased hepatic capacity for the elimination of N through urea synthesis. This is probably caused by the inflammation per se, and the treatment with prednisolone may aggravate the problem, whereas the effect of biological therapy is unknown. Therefore, we examined the effects of prednisolone or infliximab on the regulation of urea synthesis in patients with active IBD.

Methods: Urea synthesis was quantified by the functional hepatic nitrogen clearance (FHNC), i.e., the slope of the linear relationship between the urea nitrogen synthesis rate and the blood α-amino nitrogen concentration during alanine infusion. Thirty-seven patients with active IBD treated with either prednisolone or infliximab were examined before and after 7 days of treatment.

Results: At baseline, the FHNC was similar in the 2 treatment groups (36 L/h). After 7 days, prednisolone increased the FHNC by 40% (55 L/h) (P = 0.03), whereas infliximab tended to reduce the FHNC by 15% (30 L/h) (P = 0.09). The changes in the FHNC differed significantly between the 2 treatment groups (P < 0.01).

Conclusions: Prednisolone treatment further upregulated urea synthesis, which increases the hepatic loss of nitrogen and promotes body catabolism. In contrast, infliximab treatment caused no such aggravation and likely reduced the N loss. These results may argue in favor of infliximab therapy for IBD and add to the pathophysiological understanding of the interplay between inflammation, catabolism, and anti-inflammatory treatment.

© Crohn's & Colitis Foundation of America, Inc.

You currently do not have access to this article.

You may need to:

Note: If your society membership provides for full-access to this article, you may need to login on your society’s web site first.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.