1
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Miao J, Herrmann SM. Immune checkpoint inhibitors and their interaction with proton pump inhibitors-related interstitial nephritis. Clin Kidney J 2023; 16:1834-1844. [PMID: 37915905 PMCID: PMC10616479 DOI: 10.1093/ckj/sfad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 11/03/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy and outcomes, leading to an expanding use in millions of patients worldwide. However, they can cause a spectrum of immune-related adverse events (irAEs). Essentially, any organs can be affected by irAEs, which have emerged as therapy-limiting side effects. In the kidneys, ICI-associated acute interstitial nephritis (ICI-AIN) leads to acute kidney injury (AKI) in 2%-5% of patients on ICI therapy. AKI associated with ICI therapy pathologically presents with AIN in nearly 90% of the cases, but the pathophysiology of ICI-AIN remains to be defined. The generation of autoreactive T cells in patients receiving AIN-inducible drugs, such as proton pump inhibitors (PPIs), is one of the leading theories, supported by a higher incidence of ICI-AIN in patients on these AIN-inducible drugs. In this review, we will discuss our understanding of the incidence, potential pathophysiological mechanisms, clinical presentations, risk factors, diagnosis, and management of PPI-related AIN and its interaction with ICI therapy.
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Affiliation(s)
- Jing Miao
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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2
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Sanchez-Alamo B, Cases-Corona C, Fernandez-Juarez G. Facing the Challenge of Drug-Induced Acute Interstitial Nephritis. Nephron Clin Pract 2023; 147:78-90. [PMID: 35830831 DOI: 10.1159/000525561] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute interstitial nephritis (AIN) is one of the chief causes of acute kidney injury (AKI). AIN might be produced by drugs, infections, autoimmune diseases, or can be idiopathic. Among these etiologies, drug-induced AIN (DI-AIN) is the dominant one in many countries. Even when DI-AIN is suspected, identification of the putative drug is challenging. SUMMARY DI-AIN is an increasingly common cause of AKI. Diagnosis continues to pose a challenge for physicians due to nonspecific clinical symptoms, and the fact that it can be triggered by a wide variety of medications. Furthermore, the gold standard for the diagnosis is kidney biopsy. All these aspects render the diagnosis more difficult. The withdrawal of the causative drug of DI-AIN is the centerpiece of the treatment, and if early restoration of original kidney function is not obtained, several studies support the treatment with steroids especially when they are started quickly. KEY MESSAGES Almost all drugs have the potential to produce drug-induced acute interstitial nephritis (DI-AIN); however, antibiotics, nonsteroidal anti-inflammatory agents, and proton pump inhibitors account for the majority of the reported cases. DI-AIN is produced by an idiosyncratic delayed type IV hypersensitivity reaction, but the precise pathophysiological mechanism remains to be elucidated. DI-AIN symptoms are nonspecific, and most of the patients will present mild symptoms including malaise, nausea, and vomiting. The classical triad, associating fever, rash, and eosinophilia, is seldom present. Nonoliguric acute kidney injury is the main renal manifestation of DI-AIN. Tubular nonnephrotic range proteinuria is usually present. Diagnosis of DI-AIN relies on maintaining a high index of suspicion in those patients at greater risk, but kidney biopsy is required to confirm diagnosis. Histologically, AIN is characterized by the presence of an extensive interstitial infiltrate, mainly composed of lymphocytes and monocytes, but eosinophils, plasma cells, histiocytes, and polymorphonuclear cells can also be found. The withdrawal of the presumed causative drug of DI-AIN is the mainstay of the treatment. When there is no evidence of kidney function recovery after an interval of 5-7 days since interrupting the treatment with the suspected drug, several studies support the treatment with steroids, especially when they are promptly started. Early corticosteroids would decrease the inflammatory infiltrates of the kidney interstitium, thus preventing the risk of subsequent fibrosis.
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3
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Jang HN, Jung S, Lee S, Chang SH, Lee TW, Bae E, Park DJ. Acute interstitial nephritis associated with ingestion of Achyranthes japonica extract: a case report. BMC Nephrol 2021; 22:121. [PMID: 33827472 PMCID: PMC8028177 DOI: 10.1186/s12882-021-02326-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Japanese chaff flower, Achyranthes japonica, is used as complementary medicine to control degenerative arthritis. Although commonly used in South Korea, there has been no report of side effects. We report the first case of acute interstitial nephritis (AIN) that occurred in a woman who ingested A. japonica extract for 4 months. CASE PRESENTATION A 56-year-old Korean woman was admitted for deterioration of renal function. She had general weakness and nausea for 1 month. Her initial blood urea nitrogen and serum creatinine levels were 26.3 mg/dL and 3.2 mg/dL, respectively. She acknowledged ingesting A. japonica extract for the past 4 months. Renal histology demonstrated AIN represented by immune cell infiltration into the interstitium, tubulitis, and tubular atrophy, but the glomeruli were intact. A. japonica was discontinued immediately and conservative management was started. Renal function was nearly restored to the baseline level without medication after 13 months. CONCLUSION This is a rare case report of AIN associated with a pure A. japonica extract. In the case of unknown etiology of AIN, physicians should ask about the use of herbal medicines, nutraceuticals, and traditional folk medicines including A. japonica.
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Affiliation(s)
- Ha Nee Jang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Sehyun Jung
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Seunghye Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Se-Ho Chang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.,Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju, South Korea
| | - Tae Won Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, 11 Samjungja-ro Sungsan-gu, Changwon, 51472, South Korea
| | - Eunjin Bae
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju, South Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, 11 Samjungja-ro Sungsan-gu, Changwon, 51472, South Korea
| | - Dong Jun Park
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea. .,Institute of Health Science, Gyeongsang National University, Jinju, South Korea. .,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, 11 Samjungja-ro Sungsan-gu, Changwon, 51472, South Korea.
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4
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Nieto-Ríos JF, Ruiz-Velásquez LM, Álvarez L, Serna-Higuita LM. Nefritis tubulointersticial aguda. Revisión bibliográfica. IATREIA 2020. [DOI: 10.17533/udea.iatreia.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La nefritis tubulointersticial aguda hace referencia a un tipo de daño renal que afecta principalmente el intersticio y ocasiona la lesión renal aguda, potencialmente reversible. Su curso puede ser subclínico, con deterioro progresivo hasta evolucionar hacia la insuficiencia renal crónica. La nefritis tubulointersticial aguda tiene múltiples etiologías, las más frecuentes son los medicamentos, productos herbales, las infecciones y las enfermedades autoinmunes.
Las principales manifestaciones clínicas son la poliuria, polaquiuria, nocturia, dolor lumbar, microhematuria y leucocituria, aunque puede ser totalmente asintomática. El tratamiento depende de la causa de base y los esteroides juegan un papel importante cuando la condición es de origen medicamentoso o autoinmune. El pronóstico generalmente es bueno, si el problema se identifica de forma oportuna y se trata adecuadamente.
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5
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Su T, Gu Y, Sun P, Tang J, Wang S, Liu G, Li X, Yang L. Etiology and renal outcomes of acute tubulointerstitial nephritis: a single-center prospective cohort study in China. Nephrol Dial Transplant 2019; 33:1180-1188. [PMID: 28992223 DOI: 10.1093/ndt/gfx247] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/25/2017] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to explore the etiology, long-term renal outcomes and affecting factors of acute tubulointerstitial nephritis (ATIN). Methods Patients with biopsy-proven ATIN from 1 January 2005 to 31 December 2013 at Peking University First Hospital were enrolled in the study and received scheduled follow-up for at least 24 months. The causes of ATIN were defined at biopsy and reclassified during follow-up. Factors affecting renal recovery at 6 months post-biopsy and estimated glomerular filtration rate (eGFR) at 12 months post-biopsy and at the end of follow-up were analyzed. Results A total of 157 ATIN patients were enrolled, with an average follow-up of 48 months (range 24-108 months). A modified etiology spectrum was identified, with a decreased proportion of drug-induced ATIN (D-ATIN, 64% at biopsy to 50% after follow-up) and an increase in autoimmune-related ATIN (22-41%) with late-onset systemic manifestations in patients who had been classified as D-ATIN or ATIN of unknown cause. Recurrent kidney injury was observed in 51% of the patients with tubulointerstitial nephritis and uveitis syndrome (TINU), 53% of those with an autoimmune disease and 8% of those with D-ATIN, resulting in prolonged immunosuppressive treatment. By 12 months, decreased eGFR (<60 mL/min/1.73 m2) was observed in 47% of the patients with D-ATIN, 74% of those with TINU and 57% of those with other autoimmune diseases. In multivariable analysis, female sex, older age, presence of hypertension and recurrent kidney injury were independent risk factors for worse renal outcomes. Conclusions Our data demonstrate that autoimmune-related ATIN may present with systemic manifestations after kidney injury and is, therefore, commonly misdiagnosed. Repeated kidney injury is not uncommon in patients with ATIN. Scheduled follow-up is, therefore, critical for defining the exact etiology and proper management of ATIN.
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Affiliation(s)
- Tao Su
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China
| | - Yanghui Gu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China.,Renal Division, Department of Medicine, Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, P.R. China
| | - Pingping Sun
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China
| | - Jiawei Tang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China
| | - Suxia Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China.,Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, P.R. China
| | - Gang Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China
| | - Xiaomei Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, P.R. China.,Peking University Institute of Nephrology, Beijing, P.R. China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, P.R. China
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Quinto LR, Sukkar L, Gallagher M. Effectiveness of corticosteroid compared with non‐corticosteroid therapy for the treatment of drug‐induced acute interstitial nephritis: a systematic review. Intern Med J 2019; 49:562-569. [DOI: 10.1111/imj.14081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Lena R. Quinto
- Sydney Medical SchoolUniversity of Sydney Sydney New South Wales Australia
| | - Louisa Sukkar
- Sydney Medical SchoolUniversity of Sydney Sydney New South Wales Australia
- The George Institute for Global HealthUNSW Sydney New South Wales Australia
- Sydney School of Public HealthThe University of Sydney Sydney New South Wales Australia
| | - Martin Gallagher
- Sydney Medical SchoolUniversity of Sydney Sydney New South Wales Australia
- The George Institute for Global HealthUNSW Sydney New South Wales Australia
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7
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New challenges in tubulointerstitial nephritis induced by drugs. Nefrologia 2019; 39:339-342. [PMID: 31076095 DOI: 10.1016/j.nefro.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/21/2018] [Accepted: 02/19/2019] [Indexed: 11/21/2022] Open
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8
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Fernandez-Juarez G, Perez JV, Caravaca-Fontán F, Quintana L, Shabaka A, Rodriguez E, Gadola L, de Lorenzo A, Cobo MA, Oliet A, Sierra M, Cobelo C, Iglesias E, Blasco M, Galeano C, Cordon A, Oliva J, Praga M. Duration of Treatment with Corticosteroids and Recovery of Kidney Function in Acute Interstitial Nephritis. Clin J Am Soc Nephrol 2018; 13:1851-1858. [PMID: 30397027 PMCID: PMC6302327 DOI: 10.2215/cjn.01390118] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/06/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Drug-induced acute interstitial nephritis represents an emerging cause of acute kidney disease, especially among polymedicated elderly patients. Although corticosteroids are frequently used, controversy exists about the timing of initiation, efficacy, safety, and duration of treatment. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a retrospective study of 182 patients with biopsy-proven drug-induced acute interstitial nephritis from 13 Spanish centers. Exposure was defined as the length of corticosteroid treatment. The main outcome was the level of serum creatinine at month 6, with respect to baseline values. RESULTS The most common offending agents were nonsteroidal anti-inflammatory drugs (27%). In 30% of patients, the offending drug could not be identified. The median time to suspected drug withdrawal was 11 days (interquartile range, 5-22). All patients presented with acute kidney disease and were treated with corticosteroids. The mean initial dose of prednisone was 0.8±0.2 mg/kg per day. High-dose corticosteroid treatment was maintained for 2 weeks (interquartile range, 1-4). After 6 months, the mean recovered GFR was 34±26 ml/min per 1.73 m2 and ten patients required maintenance dialysis. Use of high-dose corticosteroids for 3 weeks or treatment duration >8 weeks were not associated with better recovery of kidney function. In the multivariable analysis, delayed onset of steroid treatment (odds ratio, 1.02; 95% confidence interval, 1.0 to 1.04) and the presence of interstitial fibrosis of >50% on the kidney biopsy specimen (odds ratio, 8.7; 95% confidence interval, 2.7 to 27.4) were both associated with serum creatinine level at month 6 of >75%, with respect to baseline values. CONCLUSIONS High-dose corticosteroid treatment for 3 weeks or prolonged treatment for >8 weeks were not associated with greater kidney function recovery in drug-induced acute interstitial nephritis. A delay in the initiation of corticosteroids resulted in worse recovery of kidney function.
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Affiliation(s)
| | | | | | - Luis Quintana
- Department of Nephrology, Hospital Clinic i Provincial de Barcelona, Barcelona, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Clínico San Carlos, Madrid, Spain
| | - Eva Rodriguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Liliana Gadola
- Hospital de Clínicas Nefrología y Fisiopatología, Facultad de Medicina- UDeLaR, Universidad de la República Uruguay, Montevideo, Uruguay
| | | | - Maria Angeles Cobo
- Department of Nephrology Hospital Universitario General de Canarias, Tenerife, Spain
| | - Aniana Oliet
- Department of Nephrology, Hospital Severo Ochoa, Madrid, Spain
| | - Milagros Sierra
- Department of Nephrology, Hospital San Pedro, La Rioja, Spain
| | - Carmen Cobelo
- Department of Nephrology, Hospital Universitario Lugus Ausguti, Lugo, Spain
| | - Elena Iglesias
- Department of Nephrology, Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Miguel Blasco
- Department of Nephrology, Hospital Clinic i Provincial de Barcelona, Barcelona, Spain
| | - Cristina Galeano
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain; and
| | - Alfredo Cordon
- Department of Nephrology, Hospital Fundación de Alcorcón, Madrid, Spain
| | - Jesus Oliva
- CentroNacional de Epidemilogía, Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - on behalf of the Spanish Group for the Study of Glomerular Diseases (GLOSEN)
- Department of Nephrology, Hospital Fundación de Alcorcón, Madrid, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Nephrology, Hospital Clinic i Provincial de Barcelona, Barcelona, Spain
- Department of Nephrology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Hospital de Clínicas Nefrología y Fisiopatología, Facultad de Medicina- UDeLaR, Universidad de la República Uruguay, Montevideo, Uruguay
- Department of Nephrology, Hospital de Getafe, Madrid, Spain
- Department of Nephrology Hospital Universitario General de Canarias, Tenerife, Spain
- Department of Nephrology, Hospital Severo Ochoa, Madrid, Spain
- Department of Nephrology, Hospital San Pedro, La Rioja, Spain
- Department of Nephrology, Hospital Universitario Lugus Ausguti, Lugo, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Orense, Orense, Spain
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain; and
- CentroNacional de Epidemilogía, Instituto de Salud Carlos III, Madrid, Spain
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9
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Oyama S, Hosohata K, Inada A, Niinomi I, Mori Y, Yamaguchi Y, Uchida M, Iwanaga K. Drug-induced tubulointerstitial nephritis in a retrospective study using spontaneous reporting system database. Ther Clin Risk Manag 2018; 14:1599-1604. [PMID: 30233195 PMCID: PMC6130309 DOI: 10.2147/tcrm.s168696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Tubulointerstitial nephritis (TIN) is a problem in clinical settings because drug therapy is the cause in most cases. Patients often present with nonspecific symptoms, which can lead to delays in the diagnosis and treatment of the disease. The purpose of this study was to clarify the rank-order of the association of TIN with the causative drugs using a spontaneous reporting system database. Materials and methods Data were extracted from the Japanese Adverse Drug Event Report database of the Pharmaceuticals and Medical Devices Agency (Japan). Based on 5,195,890 reports of all adverse reactions, we obtained 3,088 reports of TIN caused by all drugs and calculated the reporting odds ratio (ROR) and 95% CI for TIN. Results The 5 drugs with the highest RORs were gliclazide (ROR, 30.5; 95% CI, 17.4-53.2), tosufloxacin tosilate hydrate (ROR, 29.5; 95% CI, 21.3-41.0), piperacillin-tazobactam (ROR, 24.3; 95% CI, 19.4-30.5), cefteram pivoxil (ROR, 23.5; 95% CI, 12.5-44.2), and mefenamic acid (ROR, 22.5; 95% CI, 13.4-37.7). No sex-related difference was observed in drug-induced TIN. Most of the reports about TIN onset following the administration of culprit drugs were recorded within 12 weeks. Conclusion Based on the results, a comprehensive study using a pharmacovigilance database enabled us to identify the dugs that most frequently induced TIN, so these drugs should be used carefully in clinical practice to avoid TIN.
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Affiliation(s)
- Saki Oyama
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
| | - Keiko Hosohata
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
| | - Ayaka Inada
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
| | - Iku Niinomi
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
| | - Yasuhiro Mori
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
| | - Yuki Yamaguchi
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
| | - Mayako Uchida
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
| | - Kazunori Iwanaga
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan,
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10
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Philipponnet C, Kemeny JL, Aniort J, Garrouste C, Heng AE. Immunoallergic interstitial nephritis secondary to denosumab. Joint Bone Spine 2018; 85:253-254. [DOI: 10.1016/j.jbspin.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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11
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Abstract
Proton pump inhibitors (PPIs) are widely prescribed to treat a number of gastrointestinal (GI) disorders due to excessive acid production. While effective and safe, adverse renal effects have been increasingly described in epidemiological literature. The most well-documented adverse renal outcome is acute interstitial nephritis; however, association with overall acute kidney injury has also been recently reported. Recently, two observational studies have linked PPI use with chronic kidney disease. Finally, hypomagnesemia is another reported complication and is thought to be resulting from GI loss of magnesium. This study will critically review literature on the effect of PPIs on the kidney.
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Affiliation(s)
- P Malavade
- Department of Nephrology, Narayana Hrudayalaya, Whitefield, Bengaluru, Karnataka, India.,Department of Medicine, Division of Nephrology, The Ottawa Hospital, Ottawa, Canada
| | - S Hiremath
- Department of Medicine, Division of Nephrology, The Ottawa Hospital, Ottawa, Canada
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12
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Abstract
Drugs are associated frequently with the development of various types of acute and chronic kidney diseases. Nephrotoxicity is associated most commonly with injury in the tubulointerstitial compartment manifested as either acute tubular injury or acute interstitial nephritis. A growing number of reports has also highlighted the potential for drug-induced glomerular disease, including direct cellular injury and immune-mediated injury. Recognition of drug-induced nephropathies and rapid discontinuation of the offending agents are critical to maximizing the likelihood of renal function recovery. This review will focus on the pathology and pathogenesis of drug-induced acute interstitial nephritis and drug-induced glomerular diseases.
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Affiliation(s)
- Paisit Paueksakon
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Yee J. The Tubulointerstitium: Dark Matter. Adv Chronic Kidney Dis 2017; 24:51-54. [PMID: 28284378 DOI: 10.1053/j.ackd.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Prendecki M, Tanna A, Salama AD, Tam FWK, Cairns T, Taube D, Cook HT, Ashby D, Duncan ND, Pusey CD. Long-term outcome in biopsy-proven acute interstitial nephritis treated with steroids. Clin Kidney J 2016; 10:233-239. [PMID: 28396740 PMCID: PMC5381232 DOI: 10.1093/ckj/sfw116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022] Open
Abstract
Background: There are no prospective randomized controlled trials describing the outcome of acute interstitial nephritis (AIN) treated with steroids, and retrospective studies are limited. Methods: We identified adult patients with a diagnosis of AIN without glomerular pathology over a 14-year period. Treated patients all received oral prednisolone and three also recieved IV methylprednisolone. Data were collected retrospectively on estimated glomerular filtration rate (eGFR), change in eGFR from time of biopsy, dependence on renal replacement therapy (RRT) and mortality, and outcomes were analysed according to the treatment prescribed. Results: A total of 187 eligible patients with AIN were identified and 158 were treated with steroids. There was no difference in median eGFR or dependence on RRT at the time of biopsy. Steroid-treated patients had significantly higher eGFR at all time points post-biopsy up to 24 months, when median eGFR was 43 mL/min in the steroid-treated group and 24 mL/min in the untreated group (P = 0.01). Fewer patients in the steroid-treated group were dialysis dependent by 6 months (3.2% versus 20.6%, P = 0.0022) and 24 months (5.1% versus 24.1%, P = 0.0019). Conclusions: This large retrospective study suggests a benefit of steroids in treatment of AIN with greater improvement in eGFR and fewer patients progressing to end-stage renal disease.
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Affiliation(s)
- Maria Prendecki
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Anisha Tanna
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Alan D Salama
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
| | - Frederick W K Tam
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Tom Cairns
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - David Taube
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - H Terence Cook
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Damien Ashby
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Neil D Duncan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Charles D Pusey
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
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15
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PPIs and kidney disease: from AIN to CKD. J Nephrol 2016; 29:611-6. [DOI: 10.1007/s40620-016-0309-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 04/03/2016] [Indexed: 01/06/2023]
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Muriithi AK, Leung N, Valeri AM, Cornell LD, Sethi S, Fidler ME, Nasr SH. Clinical characteristics, causes and outcomes of acute interstitial nephritis in the elderly. Kidney Int 2015; 87:458-64. [DOI: 10.1038/ki.2014.294] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 06/03/2014] [Accepted: 06/26/2014] [Indexed: 01/09/2023]
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Abstract
Acute interstitial nephritis (AIN) is an under recognized and under diagnosed cause of acute kidney injury (AKI). It is estimated to account for 15 - 20% of cases of AKI; it is the reported diagnosis in 2.8% of all kidney biopsies, and 13.5% of biopsies done specifically for acute renal failure. Considerable evidence implicates antigen initiated cell-mediated injury in the pathogenesis of AIN. Drugs account for 70% of all cases, with over 150 different agents incriminated. The remaining cases are due to infections, autoimmune diseases, and rarely idiopathic. The central component of renal injury in AIN is altered tubular function, which usually precedes decrements in filtration rate. The key to early diagnosis is vigilance for the presence of tubular dysfunction in non-oliguric individuals, especially in patients with modest but gradual increments in creatinine level. The utility of urinary biomarkers to diagnose AIN in its early nascent and potentially reversible stage remains to be determined. Prompt recognition, elimination of the offending source of antigen, and use of a limited course of steroid therapy where indicated, will result in complete resolution in ~ 65% of cases, partial resolution in up to 20%, and irreversible damage in the rest.
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Raza MN, Hadid M, Keen CE, Bingham C, Salmon AHJ. Acute tubulointerstitial nephritis, treatment with steroid and impact on renal outcomes. Nephrology (Carlton) 2013; 17:748-53. [PMID: 22817666 DOI: 10.1111/j.1440-1797.2012.01648.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use and timing of steroids in the management of acute tubulointerstitial nephritis (ATIN) remains debatable. AIMS To determine the incidence and aetiology of ATIN in our unit, and to examine trends in the use of steroids and their impact on renal outcomes. METHODS Patients with a histological diagnosis of ATIN over a 9-year period were identified and divided into steroid-treated (StG) and steroid-naïve groups (SnG). Mean change in estimated glomerular filtration rate (eGFR) was determined. RESULTS Forty-nine patients had ATIN as their main diagnosis, 67% of cases were drug-induced, and proton pump inhibitors (PPI) were the second commonest implicated drug category. Majority (75%) of patients received steroids, and eGFR improved to a significantly greater degree in these steroid-treated patients (3.4-fold improvement vs 2.0-fold in SnG; P < 0.05, unpaired t-test). Despite comparable eGFR at presentation (StG: 11.7; SnG: 15.4), steroid-treated patients were less likely to receive dialysis, although not significantly so (OR 0.27; 95% CI 0.06-1.15, P = 0.066, chi-squared test). However, there was no significant relation between the degree of eGFR improvement and delay in starting steroids (Pearson r = -0.25, P > 0.45), and no difference in eGFR at the time of last follow-up (StG: 33 ± 3; SnG: 32 ± 7; P > 0.9, unpaired t-test). CONCLUSION StG patients had a greater degree of improvement in renal function, but with no correlation between degree of improvement in eGFR and delay in starting steroids, and similar eGFR values at final follow-up. PPI were the second commonest drug category among drug-induced cases.
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Zaidan M, Lescure FX, Brochériou I, Dettwiler S, Guiard-Schmid JB, Pacanowski J, Rondeau E, Pialoux G, Girard PM, Ronco P, Plaisier E. Tubulointerstitial nephropathies in HIV-infected patients over the past 15 years: a clinico-pathological study. Clin J Am Soc Nephrol 2013; 8:930-8. [PMID: 23430209 DOI: 10.2215/cjn.10051012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The therapy and outcome of HIV infection have dramatically changed over the last 15 years, resulting in a change in renal complications. This study analyzed the characteristics of HIV-infected patients and biopsy-proven tubulointerstitial nephropathies to define disease patterns and therapeutic implications. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A clinico-pathologic retrospective study of 59 consecutive renal biopsies showing predominant tubular and/or interstitial lesions in HIV-infected patients referred to the nephrology department between 1995 and 2011 was performed. HIV-associated nephropathy and vascular diseases were excluded from the study. RESULTS Tubulointerstitial nephropathies accounted for 26.6% of 222 native renal biopsies performed in HIV-infected patients. Two pathologic groups were analyzed, tubulopathy and interstitial nephritis, which represented 49% and 51% of tubulointerstitial nephropathies, respectively. Most patients presented with AKI (76.3%) and high-grade proteinuria (57.7%). Drug-related nephrotoxicity was the leading cause (52.5%). Alternative etiologies included infections (15.2%), dysimmune disorders (8.5%), malignancies (3.4%), and chronic (10.2%) and acute (10.2%) tubulointerstitial nephropathies of undetermined origin. Tubulopathy was strongly associated with antiretroviral drug toxicity (75.9%) and mostly caused by tenofovir (55.2%), which was associated with proximal tubular dysfunction (87.5%), overt Fanconi's syndrome (37.5%), and nephrogenic diabetes insipidus (12.5%). Interstitial nephritis was associated with a broader spectrum of pathologic lesions and etiologies. CONCLUSIONS In this series, tubulointerstitial nephropathies accounted for 26.6% of renal diseases in HIV-infected patients. Considering the therapeutic implications of diagnoses of drug toxicity, infection, and dysimmune syndromes, this study underscores the importance of monitoring renal parameters in HIV-infected patients and points to the relevance of kidney biopsy to allow an accurate diagnosis.
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Affiliation(s)
- Mohamad Zaidan
- Assistance Publique-Hôpitaux de Paris, Department of Nephrology and Dialysis, Tenon Hospital, Paris, France
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Abstract
AKI occurs commonly in hospitalized patients with multiple comorbidities. In this Attending Rounds, a woman with AKI in the setting of an infection, use of antibiotics and other medications, bacteremia, and hypotension is considered. Such patients lead to a broad differential diagnosis for AKI including prerenal AKI, acute tubular injury/acute tubular necrosis, infection-related GN, and drug-induced acute interstitial nephritis. The roles of an accurate history, physical examination, laboratory data, and kidney biopsy are highlighted in establishing the correct diagnosis in such patients.
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Affiliation(s)
- Mark A Perazella
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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Goicoechea M, Rivera F, Lopez-Gomez JM. Increased prevalence of acute tubulointerstitial nephritis. Nephrol Dial Transplant 2012; 28:112-5. [DOI: 10.1093/ndt/gfs143] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mohamed N, John R. Use of renal biopsy in the elderly. Int Urol Nephrol 2010; 43:593-600. [PMID: 21113798 DOI: 10.1007/s11255-010-9874-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/04/2010] [Indexed: 12/01/2022]
Abstract
Renal biopsy is an essential tool in the management of kidney disease. A biopsy provides a diagnosis, guides therapy and aids in prognosis, and this is true for persons of all ages. For a variety of reasons, nephrologists are sometimes hesitant to perform a biopsy in an older person. There is the major issue of a lack of perceived benefit that the biopsy will not show a treatable lesion and that therapy may not be possible in an older person. Additionally, concerns of safety may also influence the decision to biopsy. In this review, we will address these issues in the context of clinical renal syndromes and common kidney diseases in the elderly and weigh the benefit of biopsy in various situations. In general, the indications are the same as in the adult population, as is the risk associated with the biopsy procedure. Therapy, as for adults, is often successful, although further assessment of risk-benefit ratio is necessary. Age, by itself, is not a contraindication to biopsy.
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Affiliation(s)
- Nasreen Mohamed
- Department of Pathology, University Health Network, 200 Elizabeth St., 11 Eaton, Toronto, ON, M5G 2C4, Canada
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Abstract
Acute interstitial nephritis (AIN) is a common cause of acute kidney injury. Many etiologies of AIN have been recognized--including allergic/drug-induced, infectious, autoimmune/systemic, and idiopathic forms of disease. The most common etiology of AIN is drug-induced disease, which is thought to underlie 60-70% of cases. Multiple agents from many different classes of drugs can cause AIN, and the clinical presentation and laboratory findings vary according to the class of drug involved. AIN is characterized by interstitial inflammation, tubulitis, edema, and in some cases, eventual interstitial fibrosis. A definitive diagnosis of AIN can be established only by kidney biopsy. Noninvasive tests such as (67)gallium scintigraphy and testing for eosinophiluria have limited diagnostic utility. The mainstay of therapy for drug-induced AIN is timely discontinuation of the causative agent. Although the benefits of corticosteroid therapy remain unproven, they do appear to have a positive effect in some patients with drug-induced AIN, especially when treatment is initiated early in the course of the disease. In general, the prognosis for drug-induced AIN is good, and at least partial recovery of kidney function is normally observed. Early recognition is crucial because patients can ultimately develop chronic kidney disease.
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Parkhie SM, Fine DM, Lucas GM, Atta MG. Characteristics of patients with HIV and biopsy-proven acute interstitial nephritis. Clin J Am Soc Nephrol 2010; 5:798-804. [PMID: 20338962 DOI: 10.2215/cjn.08211109] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to describe the characteristics of patients with HIV infection and biopsy-proven acute interstitial nephritis (AIN). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Pathology reports were reviewed for patients who had HIV infection and underwent renal biopsy at Johns Hopkins Hospital from January 1, 1995, through January 1, 2008. Patients who received a diagnosis of AIN without evidence of HIV-associated nephropathy were identified, and their clinical course was reviewed up to 18 months after biopsy. RESULTS Of 262 biopsies, 29 (11%) patients who had AIN without evidence of HIV-associated nephropathy were identified. The mean age at the time of biopsy was 47.5 years (range 28 to 71 years), 17 (59%) were men, and 23 (79%) were black. The majority (62%) of patients were on antiretroviral therapy, 59% were current or former intravenous drug users, and 62% had hepatitis C co-infection. Drugs were identified as the cause of AIN in the majority (72%) of cases. Nonsteroidal anti-inflammatory drugs were most commonly implicated, followed by sulfamethoxazole/trimethoprim. Antiretroviral therapy was identified as the cause in only three cases. None of the patients presented with the classic triad of fever, rash, and pyuria, and only seven (24%) patients presented with <1 g/d proteinuria. CONCLUSIONS In our series, AIN was prevalent (11%) and was often drug induced. AIN should not be excluded from the differential diagnosis on the basis of absence of the classic clinical triad of fever, rash, and pyuria.
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Affiliation(s)
- Shyam M Parkhie
- Division of Renal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Abstract
The aging kidney undergoes several important anatomic and physiologic changes that increase the risk of acute kidney injury (formerly acute renal failure) in the elderly. This article reviews these changes and discusses the diagnoses frequently encountered in the elderly patient with acute kidney injury. The incidence, staging, evaluation, management, and prognosis of acute kidney injury are also examined with special focus given to older adults.
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Leung N, Eirin A, Irazabal MV, Maddox DE, Gunderson HD, Fervenza FC, Garovic VD. Acute Kidney Injury in Patients with Inactive Cytochrome P450 Polymorphisms. Ren Fail 2009; 31:749-52. [DOI: 10.3109/08860220903118608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- U C Brewster
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut 06520-9029, USA
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Geevasinga N, Coleman PL, Webster AC, Roger SD. Proton pump inhibitors and acute interstitial nephritis. Clin Gastroenterol Hepatol 2006; 4:597-604. [PMID: 16630752 DOI: 10.1016/j.cgh.2005.11.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Proton pump inhibitors (PPIs) are a widely prescribed class of drugs, and their usage worldwide is increasing. Although well-tolerated, there have been case reports and a recent case series implicating these drugs in acute interstitial nephritis (AIN) and progression to acute renal failure (ARF). The aim of this study was to investigate how widespread this complication is in Australia, to identify which PPIs are implicated, and to establish whether PPI-induced AIN is a class effect. METHODS We undertook a retrospective case review of potential cases at 2 teaching hospitals and a review of registry data from the Therapeutic Goods Administration of Australia (TGA). Parameters sought included the drug implicated, concurrent medications, symptoms, signs, serum creatinine, and time of onset after prescription. RESULTS We identified 18 cases of biopsy-proven PPI-induced AIN causing ARF in the retrospective case review, which is the largest hospital-based case series to date. The TGA registry data identified an additional 31 cases of "biopsy proven interstitial nephritis." An additional 10 cases of "suspected interstitial nephritis," 20 cases of "unclassified acute renal failure," and 26 cases of "renal impairment" were also identified. All 5 commercially available PPIs were implicated in these cases. CONCLUSION With the ever more widespread use of this class of medications, PPI-induced AIN is likely to become more frequent. There is now evidence to incriminate all the commercially available PPIs, suggesting there is a class effect. Failure to recognize this entity might have catastrophic long-term consequences including chronic kidney disease. Increased awareness might facilitate more rapid diagnosis and management of this potentially reversible condition.
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Affiliation(s)
- Nimeshan Geevasinga
- University of Sydney, Sydney, and Department of Medicine, Manly Hospital, Australia
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31
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Affiliation(s)
- J Rossert
- Hôpitaux de Paris (AP-HP), and INSERM U489, Paris, France.
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