Immunoallergic Granulomatous Interstitial Nephritis following Treatment with Omeprazole

Abstract

A 69-year-old male who had a long history of ocular myasthenia was treated with omeprazole for 3 months. Progressive renal insufficiency was discovered fortuitously. There were no clinical or laboratory manifestations of immunoallergy. Renal biopsy revealed severe granulomatous interstitial nephritis, tubular injury and fibrosis. Histology of a liver nodule disclosed hepatic granulomatous involvement. Withdrawal of omeprazole and a short course of corticosteroids were followed by improvement but not normalization of renal function. This is the eighth report of omeprazole-induced interstitial nephritis. In the present case as in 2 others in the literature, the patients had been followed up for an autoimmune disease previously, which suggests that in patients with such a background, patients should be examined regularly for renal functional impairment during treatment with omeprazole.

Granulomatous Interstitial Nephritis, Hypercalcemia and Rapidly Progressive Kidney Failure Secondary to Sarcoidosis with Exclusive Renal Involvement

“…Even in the presence of hypercalcaemia, plasma levels of vitamin D are not always high, as in the case presented here [1,15]. Omeprazole has been involved in certain reported cases of immunoallergic GIN [21]. Hypercalcaemia is typically absent.…”

“…Unlike sarcoidosis-induced GIN, there is no proof that prednisone is effective. Withdrawal of the drug is usually enough to reverse the inflammatory process [21]. In our patient, omeprazole was not discontinued and the prednisone therapy returned calcaemia to normal with considerable improvement in renal function.…”

Systematic review: proton pump inhibitor‐associated acute interstitial nephritis

“…Following a recent rise in the use of PPIs, a number of individual case reports, case series and commentaries of PPI‐induced acute interstitial nephritis have been reported in the literature 9–49 . This has alerted the medical community to this serious complication and has placed PPIs among the principal causes of medication‐induced reversible acute renal failure.…”

Proton Pump Inhibitors and Kidney Disease—GI Upset for the Nephrologist?

“…It was the first of many that raised the possibility of a causal association between PPI therapy and AKI. Following over a decade of isolated reports, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 2 case series were published in 2006 that systematically investigated the association between PPI therapy and AIN through retrospective review of biopsy reports ( Table 1 ). 36 , 37 The first, a study from Australia, found 18 cases with biopsy-proven AIN in 2 hospitals over a 10-year period.…”