Systematic review: proton pump inhibitor‐associated acute interstitial nephritis

Abstract

SUMMARY BackgroundA number of recent case reports and case series suggest that proton pump inhibitors may cause acute interstitial nephritis.

Distal Renal Tubular Acidosis that Became Exacerbated by Proton Pump Inhibitor Use

“…In the present case, the possibility of AIN was initially considered because N-acetyl-β-D-glucosaminidase (NAG) and beta-2 microglobulin (β2-MG), markers of interstitial nephritis, were both elevated. However, in our study, potassium supplementation stabilized the NAG and β2MG levels to within the normal range without the need for glucocorticoid administration or hemodialysis, which is often required in the treatment of AIN induced by PPI (10). Furthermore, the NAG and β2MG levels were not elevated during the PPI challenge test.…”

Proton pump inhibitors: are they safe on kidneys: a histopathological study

“…As postulated by some researchers this can be attributed to idiosyncratic reaction. 1,12,19 It is possible to infer that if we would have stopped the drug at the first confirmed sign of deranged renal function, we could have seen reversal of the damage and confirmation of the postulate. 1,7 However since our aim was to first asses that the damage is produced and it is like AIN by HPE methodology, we accept this limitation of the study.…”

“…14 In the electronic search study conducted by Sierra F et al, for articles written in between 1970-2006, studies with high level evidence (such as randomized trials) addressing the research question could not be found. 12 All of the information came from observational case reports and case studies that cannot control for confounding factors both known and unknown. 12 More than half of the samples of patients were on other medications capable of causing AIN, or had co-morbidities known to be risk factor for the development of renal failure.…”

“…12 All of the information came from observational case reports and case studies that cannot control for confounding factors both known and unknown. 12 More than half of the samples of patients were on other medications capable of causing AIN, or had co-morbidities known to be risk factor for the development of renal failure. 12 Because of that it is difficult to establish causality relationship and determine the AIN is due to PPI or the other coprescribed medication.…”

“…10,11 The PPI induced AIN is postulated to be an idiosyncratic reaction; hence it is difficult to identify the condition. 1,8,[10][11][12] The exact rate of this rare adverse event is difficult to estimate as many patients are taking multiple medications, which also make it difficult to establish the causal relationship between AIN and PPI. 1 The recognition and diagnosis of AIN is vitally important because the condition is potentially reversible.…”