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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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Jafri F, Taylor ZL, Gonzalez D, Shakhnovich V. Effects of obesity on the pharmacology of proton pump inhibitors: current understanding and future implications for patient care and research. Expert Opin Drug Metab Toxicol 2023; 19:1-11. [PMID: 36800927 PMCID: PMC10065909 DOI: 10.1080/17425255.2023.2178897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/07/2023] [Indexed: 02/20/2023]
Abstract
INTRODUCTION In the United States, obesity affects approximately ⅖ adults and ⅕ children, leading to increased risk for comorbidities, like gastroesophageal reflux disease (GERD), treated increasingly with proton pump inhibitors (PPIs). Currently, there are no clinical guidelines to inform PPI dose selection for obesity, with sparse data regarding whether dose augmentation is necessary. AREAS COVERED We provide a review of available literature regarding the pharmacokinetics (PK), pharmacodynamics (PD), and/or metabolism of PPIs in children and adults with obesity, as a step toward informing PPI dose selection. EXPERT OPINION Published PK data in adults and children are limited to first-generation PPIs and point toward reduced apparent oral drug clearance in obesity, with equipoise regarding obesity impact on drug absorption. Available PD data are sparse, conflicting, and limited to adults. No studies are available to inform the PPI PK→PD relationship in obesity and if/how it differs compared to individuals without obesity. In the absence of data, best practice may be to dose PPIs based on CYP2C19 genotype and lean body weight, so as to avoid systemic overexposure and potential toxicities, while monitoring closely for efficacy.
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Affiliation(s)
- Farwa Jafri
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO
| | - Zachary L. Taylor
- Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valentina Shakhnovich
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
- Children’s Mercy Kansas City, Kansas City, MO
- Center for Children’s Healthy Lifestyles and Nutrition, Kansas City, MO
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Belayneh YM, Amare GG, Meharie BG, Kifle ZD. Evaluation of the antiulcerogenic activity of hydromethanol extracts of Solanum incanum L. (Solanaceae) leaves and roots in mice; single and repeated dose study. Metabol Open 2021; 11:100119. [PMID: 34485890 PMCID: PMC8403757 DOI: 10.1016/j.metop.2021.100119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to evaluate the antiulcer activity of hydromethanol extracts of Solanum incanum L. (Solanaceae) leaves and roots in mice. Methods The antiulcerogenic activity of the plant extracts were evaluated using Pylorus ligation and ethanol induced gastric ulcers in fasted mice. Data were analyzed using one way ANOVA, and P-values <0.05 were considered statistically significant. Result:Pylorus ligation-induced ulcer Single dose and repeated daily dose administration of the leaf and root extracts for 10 days didn't significantly (P > 0.05) affect pH, total acidity and volume of gastric secretion. Single dose of both extracts significantly reduced ulcer score (P = 0.036) and ulcer index (leaf, P = 0.037; root, P = 0.041) at the dose of 400 mg/kg. Similarly, significant reduction in ulcer score was observed after repeated daily treatment with 200 mg/kg (P = 0.030) and 400 mg/kg (P = 0.005) of the leaf extract and 400 mg/kg (P = 0.005) of the root extract. In addition, repeated administration of 400 mg/kg of the leaf (P = 0.004) and root (P = 0.005) extracts significantly reduced ulcer index. Ethanol-induced ulcer Single dose of both extracts significantly reduced ulcer score at the dose of 200 mg/kg (leaf, P = 0.017; root, P = 0.036) and 400 mg/kg (leaf, P = 0.001; root, P = 0.001). Similarly, 200 mg/kg (leaf, P = 0.002; root, P = 0.018) and 400 mg/kg (leaf, P = 0.001; root, P = 0.001) of the extracts significantly reduced ulcer index after single dose treatment. Repeated daily treatment with leaf and root extracts for ten days caused a significant (P = 0.037, 0.001 and 0.001 for 100, 200 and 400 mg/kg leaf extract; P = 0.026, 0.018 and 0.001 for 100, 200 and 400 mg/kg root extract, respectively) reduction in ulcer score. In addition, both extracts significantly (P = 0.041, 0.004 and 0.000 for 100, 200 and 400 mg/kg leaf extract; P = 0.038, 0.008 and 0.000 for 100, 200 and 400 mg/kg root extract, respectively) reduced ulcer index after 10 days of treatment. Conclusion This study has revealed hydromethanol extracts of Solanum incanum leaves and roots have antiulcerogenic activity using in vivo models. The antiulcer activity of the plant is not related to acid anti-secretory action, suggesting the plant may have cytoprotective effect on the gastric mucosa.
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Affiliation(s)
- Yaschilal Muche Belayneh
- Department of Pharmacy, College of medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Gedefaw Getnet Amare
- Department of Pharmacy, College of medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Birhanu Geta Meharie
- Department of Pharmacy, College of medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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He Q, Ying G, Fei X, Zha C, Chen Z, Bao Y, Long J, Wang Z, He X, Xia M. Drug rash with eosinophilia and systemic symptoms and severe renal injury induced by proton pump inhibitor therapy: A case report. Medicine (Baltimore) 2020; 99:e22509. [PMID: 33080685 PMCID: PMC7572029 DOI: 10.1097/md.0000000000022509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) are widely prescribed and generally well tolerated but can rarely cause severe allergic reactions, such as drug rash with eosinophilia and systemic symptoms (DRESS). We report a case of DRESS and renal injury induced by PPIs, and describe the therapeutic process. PATIENT CONCERNS The patient was a 66-year-old female who complained of fever, pruritus, desquamation, erythema multiforme, and anuria caused by omeprazole taken for 2 weeks to treat abdominal distention. DIAGNOSIS The clinical history revealed a similar episode of PPI-induced fever, eosinophilia, and acute kidney injury more than 1 year ago. The present laboratory tests revealed eosinophilia and oliguric renal failure. The renal biopsy was performed subsequently and proved the diagnosis of PPI-induced DRESS. INTERVENTIONS After the suspected diagnosis of PPI-induced DRESS, omeprazole was discontinued and methylprednisolone infusion (40 mg qd) was initiated. Because of oliguric renal failure, the patient received intermittent hemodialysis. OUTCOMES The patient initially responded to omeprazole discontinuation, hemodialysis, and glucocorticoids but later died from severe infection during the tapering of glucocorticoid therapy. CONCLUSION Clinicians should remain on high alert for potential life-threatening complications when prescribing PPIs. If unexplained renal injury develops in a patient taking a PPI, renal biopsy may help in identifying the pathogenesis and might facilitate timely intervention.
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Affiliation(s)
- Qien He
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Guanghui Ying
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Xiapei Fei
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Chenqin Zha
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Zhaogui Chen
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Yishu Bao
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Jiaorong Long
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Zhujun Wang
- Department of Nephrology, Beilun People's Hospital, Ning Bo
| | - Xuelin He
- Department of Nephrology, Beilun People's Hospital, Ning Bo
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province
- The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Min Xia
- Department of Nephrology, Beilun People's Hospital, Ning Bo
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Ahmed S, Belayneh YM. Helicobacter pylori And Duodenal Ulcer: Systematic Review Of Controversies In Causation. Clin Exp Gastroenterol 2019; 12:441-447. [PMID: 31819586 PMCID: PMC6873956 DOI: 10.2147/ceg.s228203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background There are controversies on the causal role of H. pylori in duodenal ulceration. Helicobacter pylori are curved gram-negative microaerophilic bacteria found at the layer of gastric mucous or adherent to the epithelial lining of the stomach. It’s a public health significance bacteria starting from discovery, and the prevalence and severity of the infection varies considerably among populations. H. pylori are a risk for various diseases, while the extent of host response like gastric inflammation and the amount of acid secretion by parietal cells affects the outcome of infection. Method Relevant literature were searched from databases such as Google Scholar, PubMed, Hinari, Web of Science, Scopus, and Science Direct. Result The review evidence supports a strong causal relation between H. pylori infection and duodenal ulcer, as patients are more likely to be infected by virulent strains which later cause duodenal ulceration. Thus, eradication of H. pylori infection decreases the incidence of duodenal ulcers, and prevents its recurrence by reducing both basal gastrin release and acid secretion without affecting parietal cell sensitivity. On the other hand, some studies show that H. pylori infection is not associated with the development of duodenal ulcers and such a lack of association revealed that duodenal ulceration has different pathogenesis. Conclusion Despite controversies observed in the causal role of H. pylori to duodenal ulceration by various studies, Hill criteria of causation proved the presence of a causal relation between H. pylori infection and duodenal ulcers. Other factors are also responsible for the development of duodenal ulcers and such factors are responsible for the differences in the prevalence of the diseases.
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Affiliation(s)
- Solomon Ahmed
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yaschilal Muche Belayneh
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Peng T, Hu Z, Zheng H, Zhen J, Ma C, Yang X. Pantoprazole-induced acute kidney injury: A case report. Exp Ther Med 2018; 15:5302-5306. [PMID: 29805547 PMCID: PMC5958704 DOI: 10.3892/etm.2018.6088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022] Open
Abstract
The present study reports a case of pantoprazole-induced acute kidney disease. The patient was diagnosed with acute kidney injury with wide interstitial inflammation and eosinophil infiltration. Following 1 month of glucocorticoid therapy, the patient's serum creatinine and urea nitrogen decreased to within normal ranges. The presentation, clinical course, diagnosis and prognosis of pantoprazole-induced acute kidney injury are discussed herein to highlight the importance of early and correct diagnosis for good prognosis. Disease characteristics include short-term increased serum creatinine levels that respond to glucocorticoid treatment. The patient had no history of chronic kidney disease or proteinuria and presented with increased serum creatinine following treatment with pantoprazole. Following the end of pantoprazole treatment, short-term RRT and long-term prednisolone was administered, then serum creatinine returned to normal. Pantoprazole-induced acute kidney injury is commonly misdiagnosed and late diagnosis results in poor patient prognoses. Misdiagnosis leads to the administration of treatments that may exacerbate the condition, so appropriate diagnosis and treatment for pantoprazole-induced acute kidney injury is necessary.
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Affiliation(s)
- Tao Peng
- Department of Nephrology, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China
| | - Zhao Hu
- Department of Nephrology, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China
| | - Hongnan Zheng
- Department of Nephrology, Jinan Third People's Hospital, Jinan, Shandong 250010, P.R. China
| | - Junhui Zhen
- Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China
| | - Chengjun Ma
- Department of Nephrology, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China
| | - Xiangdong Yang
- Department of Nephrology, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China
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Toth-Manikowski S, Grams ME. Proton Pump Inhibitors and Kidney Disease - GI Upset for the Nephrologist? Kidney Int Rep 2017; 2:297-301. [PMID: 28845467 PMCID: PMC5568828 DOI: 10.1016/j.ekir.2017.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Widely regarded as safe and effective, proton pump inhibitors (PPIs) are among the most commonly used medications in the world today. However, a spate of observational studies suggest an association between PPI use and adverse events, including infection, bone fracture, and dementia. This review details evidence linking the use of PPI therapy to the development of kidney disease, including early case reports of acute interstitial nephritis and subsequent large observational studies of acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD). The majority of studies showed higher risk of kidney outcomes among persons prescribed PPI medications, with effect sizes that were slightly higher for AKI (∼2-3-fold) compared to CKD and ESRD (1.2-1.8-fold). Although observational pharmaco-epidemiology studies are limited by the possibility of residual confounding and confounding by indication, many of the described studies conducted rigorous sensitivity analyses aimed at minimizing these biases, including new-user design, comparison to similar agents (e.g., histamine2 receptor antagonists), and evaluation for a dose-response, with robust results. Given the widespread use of PPIs, even a small effect on kidney outcomes could result in large public health burden. Timely cessation of PPI therapy when there is no clear indication for use might reduce the population burden of kidney disease.
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Affiliation(s)
| | - Morgan E Grams
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore Maryland
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Purt B, Hiremath S, Smith S, Erzurum S, Sarac E. A Rare Case of Tubulointerstitial Nephritis and Uveitis Syndrome Treated with a Multi-Specialty Approach. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:869-873. [PMID: 27867184 PMCID: PMC5119685 DOI: 10.12659/ajcr.900701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Female, 23 Final Diagnosis: Tubulointerstitial nephritis and uveitis syndrome Symptoms: Abdominal pain • eye redness Medication: — Clinical Procedure: — Specialty: Opthalmology
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Affiliation(s)
| | - Siri Hiremath
- Department of Internal Medicine and The Transitional Residency, St. Elizabeth Youngstown Hospital, Youngstown, OH, USA
| | | | - Sergul Erzurum
- Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Erdal Sarac
- Department of Medicine, Northeast Ohio Medical University, Nephrology Associates, Inc., Rootstown, OH, USA
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9
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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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Torlot FJA, Whitehead DJ. Acute interstitial nephritis caused by two different proton pump inhibitors. Br J Hosp Med (Lond) 2016; 77:50-1. [PMID: 26903459 DOI: 10.12968/hmed.2016.77.1.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Frederick J A Torlot
- Foundation Year 2 Doctor in the Department of Gastroenterology and Hepatology, Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA
| | - Duncan J Whitehead
- Consultant Acute Physician and Nephrologist in the Department of Acute Internal Medicine and Nephrology, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA
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Affiliation(s)
- Ju Wan Kang
- Clinical Assistant Professor, Jeju National University School of Medicine, Jeju 690-756, South Korea
| | - Jeong Hong Kim
- Associate Professor in the Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju 690-756, South Korea
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Jain D, Katti N. Combination treatment of lycopene and hesperidin protect experimentally induced ulcer in laboratory rats. JOURNAL OF COMPLEMENTARY MEDICINE RESEARCH 2015; 4:143-6. [PMID: 26401402 PMCID: PMC4566771 DOI: 10.5455/jice.20150314061404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/16/2015] [Indexed: 11/03/2022]
Abstract
AIM Lycopene, a carotenoid and hesperidin, a flavonoid are naturally occurring in vegetables and fruits. Synergistic effect of a combination of carotenoid and flavonoid has been reported due to its antioxidant activity. Therefore, the present study was aimed to evaluate the protective effect of this combination on pylorus ligation induced ulcers in rats. MATERIALS AND METHODS Thirty Wistar albino rats were divided into five groups (n = 6). Rats were fasted for 24 h before pylorus ligation. After 24 h of fasting the rats were treated with hesperidin (100 mg/kg) and lycopene (2 mg/kg) and their combination 1h prior to surgery. After an hour under ether anesthesia pylorus ligation was performed, after 5 h the animals were sacrificed, stomach was dissected, and gastric contents were collected and measured. Total acidity and pH of gastric content was estimated. Ulcer index was calculated, and macroscopic examination of the stomach was carried out. RESULTS The sham operated rats showed a significant increase in pH, volume of gastric content and total acidity and ulcer index. The rats pretreated with lycopene and hesperidin showed significant improvement in the ulcer conditions. However, rats treated with a combination of lycopene and hesperidin showed more significant restoration of gastric function as compared to sham operated rats. Moreover, a significant difference was also noted in rats treated with a combination as compared to lycopene and hesperidin treatment alone. CONCLUSION Thus experimentally the combination was seen to treat ulcers by anti-secretory, neutralizing, cytoprotective and mainly due to its antioxidant property.
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Affiliation(s)
- Dilpesh Jain
- Department of Pharmacology, Sinhgad College of Pharmacy, Vadgaon, Pune, Maharashtra, India
| | - Neha Katti
- Department of Pharmacology, Sinhgad College of Pharmacy, Vadgaon, Pune, Maharashtra, India
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Schiller D, Maieron A, Schöfl R, Donnerer J. Drug fever due to a single dose of pantoprazole. Pharmacology 2014; 94:78-9. [PMID: 25228460 DOI: 10.1159/000364781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/22/2014] [Indexed: 01/25/2023]
Abstract
Although proton pump inhibitors (PPI) are generally well tolerated, with most adverse effects being minor and self-limiting, there are singular reports on hypersensitivity immune reactions triggered by a PPI or its metabolites. Here we report a case of acute drug-induced fever with leukocytosis and a transient increase in CRP due to pantoprazole. This was apparently an idiosyncratic reaction (inflammatory fever), showing no cross-sensitivity towards esomeprazole.
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Affiliation(s)
- Dietmar Schiller
- Department of Internal Medicine IV, Elisabethinen Hospital, Linz, Austria
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Wilhelm SM, Rjater RG, Kale-Pradhan PB. Perils and pitfalls of long-term effects of proton pump inhibitors. Expert Rev Clin Pharmacol 2014; 6:443-51. [PMID: 23927671 DOI: 10.1586/17512433.2013.811206] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review summarizes the literature regarding long-term adverse effects of proton pump inhibitors (PPIs). A PubMed search (1966 to February 2013) for English language studies was conducted using key terms PPI: omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole, pneumonia, Clostridium difficile, osteoporosis, risk of fractures, thrombocytopenia, rhabdomyolysis, anemia, iron deficiency, hypomagnesemia, vitamin B₁₂ and nephritis. The risk of pneumonia was increased 27-39% in short-term use of PPIs in three meta-analyses. C. difficile infections were also associated with the use of PPIs (odds ratio: 2.15; 95% CI: 1.81-2.55; p < 0.00001). This effect appears to be dose related. The US FDA has recently issued a warning regarding fractures and the impaired magnesium absorption associated with the use of PPI. Thrombocytopenia, iron deficiency, vitamin B12 deficiency, rhabdomyolysis and acute interstitial nephritis have also been reported with the use of PPIs. There is mounting evidence that PPIs are associated with serious adverse effects. Practitioners should be vigilant and counsel patients accordingly.
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Affiliation(s)
- Sheila M Wilhelm
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
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Kumar D, Hegde HV, Patil PA, Roy S, Kholkute SD. Antiulcer activity of water soaked Glycine max L. grains in aspirin induced model of gastric ulcer in Wistar rats. J Ayurveda Integr Med 2013; 4:134-7. [PMID: 24250141 PMCID: PMC3821186 DOI: 10.4103/0975-9476.118679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/11/2013] [Accepted: 06/22/2013] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Glycine max L. with Drakshasava, widely used by traditional healers as a formulation for the treatment of peptic ulcer in rural northern Karnataka in India, appears to be effective as assessed by patients and in our previously published research work of traditionally used formulation. AIM The present study was undertaken to evaluate the safety and efficacy of the overnight water soaked G. max grains. This is one of the components of traditional formulation. The study, approved by Institutional Animal Ethics Committee was carried out in male Wistar rats after assessing its toxicity in mice. MATERIALS AND METHODS Four groups of rats (n = 6 in each group) were treated with aspirin 200 mg/kg oral. In addition to aspirin control group received normal saline, standard group received 20 mg/kg omeprazole and 3(rd) and 4(th) group received G. max 250 and 500 mg/kg, respectively. All treatments were administered orally every 24 h for 7 days. After 24 hours fasting, on the 8(th) day stomach contents were aspirated under anesthesia to estimate free and total acidity. Stomachs were opened along the greater curvature to calculate ulcer index and subjected to histopathology studies. STATISTICS The results were analyzed by one-way analysis of variance followed-by Dunnett's post hoc test. P ≤0.05 was considered as significant. RESULTS The severity of aspirin induced ulceration was found significantly (P < 0.05) decreased in test groups compared with the control group. Free and total acidity was significantly reduced in 500 mg/kg treated group, compared with the control group and was inferior to omeprazole treated group. CONCLUSION The grain of G. max was found to be effective against aspirin induced ulcers.
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Klassen S, Krepinsky JC, Prebtani APH. Pantoprazole-induced acute interstitial nephritis. CMAJ 2012; 185:56-9. [PMID: 23109611 DOI: 10.1503/cmaj.120954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sheila Klassen
- Department of Medicine, McMaster University, Hamilton, Ont., Canada.
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Exfoliative erythrodermia induced by pantoprazole. Allergol Immunopathol (Madr) 2012; 40:194-5. [PMID: 21620552 DOI: 10.1016/j.aller.2011.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 02/15/2011] [Accepted: 03/03/2011] [Indexed: 11/21/2022]
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Protective effect of Polyalthia longifolia var. pendula leaves on ethanol and ethanol/HCl induced ulcer in rats and its antimicrobial potency. ASIAN PAC J TROP MED 2011; 4:673-9. [DOI: 10.1016/s1995-7645(11)60172-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/11/2011] [Accepted: 07/15/2011] [Indexed: 11/22/2022] Open
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19
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Study of anti ulcer activity of Ficus religiosa L. on experimentally induced gastric ulcers in rats. ASIAN PAC J TROP MED 2010. [DOI: 10.1016/s1995-7645(10)60189-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Determining drug causation from geriatric clinical observations: The case study of a suspected hypersensitivity vasculitis with glomerular involvement associated with lansoprazole. Eur Geriatr Med 2010. [DOI: 10.1016/j.eurger.2010.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mathews S, Reid A, Tian C, Cai Q. An update on the use of pantoprazole as a treatment for gastroesophageal reflux disease. Clin Exp Gastroenterol 2010; 3:11-6. [PMID: 21694841 PMCID: PMC3108659 DOI: 10.2147/ceg.s6355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Indexed: 12/22/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is a chronic, recurrent disease that affects nearly 19 million people in the US. The mainstay of therapy for GERD is acid suppression. Proton pump inhibitors (PPIs) are the most effective medication for both initial treatment and maintenance therapy of GERD. Pantoprazole, a first-generation PPI, was approved by the FDA in 2000 for the treatment of erosive esophagitis associated with GERD. It has been used in more than 100 different countries worldwide. It is one of the few PPIs available in multiple forms: a delayed-release oral capsule, oral suspension, and intravenous. Pantoprazole been shown to improve acid reflux-related symptoms, heal esophagitis, and improve health-related quality of life more effectively than histamine-2 receptor antagonists. Evaluated in over 100 clinical trials, pantoprazole has an excellent safety profile, is as efficacious as other PPIs, and has a low incidence of drug interactions. It has also been shown to be safe and effective in special patient populations, such as the elderly and those with renal or moderate liver disease.
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Affiliation(s)
- Sony Mathews
- Division of Digestive Diseases, Department of Medicine, Emory University, School of Medicine, Atlanta, GA, USA
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Abstract
Drugs such as antibiotics, non-steroidal anti-inflammatory drugs and proton pump inhibitors, infections and systemic diseases can trigger interstitial nephritis. The clinical outcome varies from asymptomatic progression to acute kidney injury. Interstitial nephritis often leads to characteristic and detectable partial tubular disorders such as tubular proteinuria (alpha(1)-microglobulin), phosphaturia with hypophosphatemia, aminoaciduria, diminished H(+) secretion with metabolic acidosis with inadequate high urinary pH, glucosuria and salt loss. The main principle of treatment is avoidance of the inducing agent. In addition corticosteroids have been proven usable after exclusion of an infection so that a good prognosis can be expected for acute nephritis in the majority of cases. In chronic forms the interstitial nephritis involves the glomeruli as well as potentially resulting in end-stage renal failure in the long run. Supportive therapies are then required in the sense of chronic renal failure in order to prevent further functional loss up to end-stage renal disease.
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Affiliation(s)
- J Halbritter
- Medizinische Klinik und Poliklinik für Endokrinologie und Nephrologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, A.ö.R., Leipzig, Liebigstr. 20, 04159, Leipzig, Deutschland
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Krishnamurthy M, Snyder R, Bachurina M. LONG-TERM USE OF PROTON PUMP INHIBITORS: ARE THEY REALLY SAFE? A CASE OF DELAYED ACUTE INTERSTITIAL NEPHRITIS. J Am Geriatr Soc 2009; 57:1513-4. [DOI: 10.1111/j.1532-5415.2009.02409.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ricketson J, Kimel G, Spence J, Weir R. Acute allergic interstitial nephritis after use of pantoprazole. CMAJ 2009; 180:535-8. [PMID: 19255077 DOI: 10.1503/cmaj.080456] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jeffrey Ricketson
- The Faculty of Medicine, University of British Columbia, Vancouver, BC
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Arend LJ, Nadasdy T. Emerging therapy-related kidney disease. Arch Pathol Lab Med 2009; 133:268-78. [PMID: 19195969 DOI: 10.5858/133.2.268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Many new therapies have emerged within the last 5 to 10 years to treat a variety of conditions. Several of these have direct or indirect renal toxicities that may go undiagnosed without careful attention of the pathologist to a patient's clinical history, particularly the addition of new medications or treatments. OBJECTIVE To discuss patterns of renal injury resulting from medications or therapeutic regimens that have been introduced within the last 10 years. Recognition of these patterns may allow the pathologist to alert the attending clinician to a possible drug-induced renal injury and prevent further deterioration of renal function and possible chronic kidney disease. DATA SOURCES A review of recent literature and unpublished observations of case-derived material. CONCLUSIONS A number of newer therapies have emerged as agents of renal toxicity, producing a variety of pathologic changes in the kidney. The outcome can be acute or chronic glomerular, tubular, interstitial, and/or vascular injury. Some drugs will result in irreversible changes and end-stage renal disease, whereas many of the alterations can be reversed with removal of the offending agent, avoiding potential long-term kidney injury.
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Affiliation(s)
- Lois J Arend
- Department of Pathology and Laboratory Medicine, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
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Sierra F, Suarez M, Rey M, Vela MF. Systematic review: Proton pump inhibitor-associated acute interstitial nephritis. Aliment Pharmacol Ther 2007; 26:545-53. [PMID: 17661758 DOI: 10.1111/j.1365-2036.2007.03407.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A number of recent case reports and case series suggest that proton pump inhibitors may cause acute interstitial nephritis. AIM To establish the nature of the relationship (cause or association) between proton pump inhibitor use and development of interstitial nephritis. DATA COLLECTION Two researchers independently searched electronic databases (MEDLINE, EMBASE, GOOGLE, LILACS, COCHRANE) for articles from 1970 to 2006, including all study designs, populations and languages. Two independent reviewers assessed study quality and collected the data. SELECTION CRITERIA absence of baseline renal failure, development of interstitial nephritis after proton pump inhibitor exposure, nephritis confirmed by creatinine plus either renal biopsy or recurrence upon reinitiating proton pump inhibitor. RESULTS Sixty four cases (60% females, mean age 78 years) of proton pump inhibitor-associated interstitial nephritis were found, 60 included in this review (59 confirmed by renal biopsy, one by recurrence upon reinitiating proton pump inhibitor). The most common symptoms were non-specific. The mean proton pump inhibitor treatment duration before diagnosing nephritis was 13 weeks, average recovery time was 35.5 weeks, one patient required permanent dialysis, there were no deaths. CONCLUSION Proton pump inhibitor-related interstitial nephritis is rare, idiosyncratic and difficult to predict. It requires a high level of clinical suspicion. While there is not sufficient evidence to establish a causal relationship with certainty, there does appear to be a low-prevalence association.
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Affiliation(s)
- F Sierra
- Division of Gastroenterology and Hepatology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Härmark L, van der Wiel HE, de Groot MCH, van Grootheest AC. Proton pump inhibitor-induced acute interstitial nephritis. Br J Clin Pharmacol 2007; 64:819-23. [PMID: 17635502 PMCID: PMC2198775 DOI: 10.1111/j.1365-2125.2007.02927.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIM To investigate the association between the use of proton pump inhibitors (PPIs) and acute interstitial nephritis (AIN). METHODS The Netherlands Pharmacovigilance Centre Lareb received seven case reports of AIN induced by various PPIs. In five of the reports it was mentioned that the diagnosis was confirmed by a renal biopsy. RESULTS The time to onset varied between hours to 4 months. In all cases but one the patient spontaneously recovered after withdrawal of the offending agent. In one case the patient received treatment with prednisolone and recovered. In one patient a rechallenge was done 9 days after the initial event. Within 12 h of re-exposure the patient developed symptoms of AIN. CONCLUSIONS The mechanism of drug-induced AIN is unknown, but an immunological mechanism is suspected. Our reports show no relation between dosage, latency, time to recovery, age or gender, supporting the hypothesis that the aetiology of AIN is immunological. Lareb has received reports of AIN with the use of omeprazole, pantoprazole and rabeprazole. This shows that AIN is a complication associated with the whole group of PPIs and not only omeprazole. It is important for health professionals to be aware of this adverse drug reaction, because an accurate and timely diagnosis and withdrawal of the offending drug can prevent potentially life-threatening renal failure.
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Affiliation(s)
- Linda Härmark
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands.
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Borruel Aguilar M, Brun Izquierdo A, Marco Catalán P, Morte Pascual A. Nefritis intersticial aguda por omeprazol. A propósito de un caso. Semergen 2007. [DOI: 10.1016/s1138-3593(07)73904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Simpson IJ, Marshall MR, Pilmore H, Manley P, Williams L, Thein H, Voss D. Proton pump inhibitors and acute interstitial nephritis: Report and analysis of 15 cases. Nephrology (Carlton) 2006; 11:381-5. [PMID: 17014549 DOI: 10.1111/j.1440-1797.2006.00651.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Although proton pump inhibitors (PPI) are usually safe and effective therapeutic agents, serious adverse effects can occur. The aim of the present study was to report and analyse the clinical features of 15 patients with acute interstitial nephritis (AIN) and acute renal failure from PPI that were referred to renal services in Auckland over a period of 3 years. METHODS The clinical presentation, therapeutic drugs, demographic details and renal outcome of the patients were considered. The population at risk and total PPI exposure were able to be defined. The diagnosis of AIN was made by renal biopsy in 12 cases. In all patients, the time-course of drug exposure and improvement of renal function on withdrawal suggested PPI were causal. RESULTS The median patient age was 78 years. The mean baseline serum creatinine level was 83 micromol/L, peak level 392 micromol/L, and recovery level 139 micromol/L. The erythrocyte sedimentation rate (ESR) and C-reactive protein were elevated at the time of diagnosis in the 11 and 12 patients, respectively, where this information was collected (ESR mean 85 mm/h, and C-reactive protein mean 81 mg/L). AIN occurred at 8 per 100 000 patient years (95% confidence level 2.6-18.7 per 100 000 patient years). Although four patients presented with an acute systemic allergic reaction, 11 were asymptomatic with an insidious development of renal failure. CONCLUSION PPI are now the most commonly identified cause of AIN in the Auckland area. Recovery occurs after withdrawal of the drug but is often incomplete. Early diagnosis may be facilitated by clinician awareness of the insidious onset of renal failure, and an elevated erythrocyte sedimentation rate and C-reactive protein.
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Affiliation(s)
- Ian J Simpson
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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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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Hiruma-Lima CA, Calvo TR, Rodrigues CM, Andrade FDP, Vilegas W, Brito ARMS. Antiulcerogenic activity of Alchornea castaneaefolia: effects on somatostatin, gastrin and prostaglandin. JOURNAL OF ETHNOPHARMACOLOGY 2006; 104:215-24. [PMID: 16253451 DOI: 10.1016/j.jep.2005.09.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Revised: 08/20/2005] [Accepted: 09/02/2005] [Indexed: 05/05/2023]
Abstract
The hydroethanolic extract of the leaves (HEL) and bark (HEB) obtained from Alchornea castaneaefolia (Euphorbiaceae) were investigated for their ability to prevent ulceration of the gastric mucosa in animal models. HEL (500 and 1000 mg/kg) and HEB (1000 mg/kg) significantly reduced the gastric injuries induced by the combination of HCl/ethanol and lowered the severity of gastric damage formation induced by indomethacin/bethanechol in mice. Further investigation showed that HEL also inhibited formation of ulcers in mice submitted to stress and pylorus ligature, but HEL did not modify gastric juice parameters in Shay mice. HEL was also effective in promoting the healing process in chronic gastric ulcer induced by acetic acid in rats. An enriched flavonoidic fraction (EFF at dose of 100mg/kg) obtained from HEL reduced gastric lesions induced by HCl/ethanol and indomethacin/bethanechol in mice. Although EFF did not modify the amount of free mucus production by gastric mucosa, it was able to increase prostaglandin production. When administered to rats submitted to ethanol-induced gastric lesions, EFF increased the somatostatin serum levels, while the gastrin serum levels were proportionally decreased. Phytochemical investigation on HEL and EFF led to the isolation of flavonoids glycosides as the main compounds, thus suggesting that these substances may be involved in the observed antiulcer activity.
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Affiliation(s)
- Clélia Akiko Hiruma-Lima
- Departamento de Fisiologia, Instituto de Biociências, Universidade Estadual Paulista (UNESP), Rubião Junior s/n, CP 510, CEP 18618-000, Botucatu, SP, Brazil
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Choudhury D, Ahmed Z. Drug-associated renal dysfunction and injury. ACTA ACUST UNITED AC 2006; 2:80-91. [PMID: 16932399 DOI: 10.1038/ncpneph0076] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 10/26/2005] [Indexed: 01/28/2023]
Abstract
Renal dysfunction and injury secondary to medications are common, and can present as subtle injury and/or overt renal failure. Some drugs perturb renal perfusion and induce loss of filtration capacity. Others directly injure vascular, tubular, glomerular and interstitial cells, such that specific loss of renal function leads to clinical findings, including microangiopathy, Fanconi syndrome, acute tubular necrosis, acute interstitial nephritis, nephrotic syndrome, obstruction, nephrogenic diabetes insipidus, electrolyte abnormalities and chronic renal failure. Understanding the mechanisms involved, and recognizing the clinical presentations of renal dysfunction arising from use of commonly prescribed medications, are important if injury is to be detected early and prevented. This article reviews the clinical features and basic processes underlying renal injury related to the use of common drugs.
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Karie S, Launay-Vacher V, Izzedine H, Deray G. Néphrotoxicité des médicaments : veille bibliographique janvier 2003–décembre 2004. Nephrol Ther 2005; 1:285-95. [PMID: 16895697 DOI: 10.1016/j.nephro.2005.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Revised: 03/24/2005] [Accepted: 06/13/2005] [Indexed: 11/17/2022]
Abstract
Drug-induced kidney injury is a major side effect in clinical practice. Renal injury associated with drugs may involve several components of the kidney: glomerulus, tubules, interstitium and blood vessels. Acute renal failure may occur as a major reaction to many drugs. Moreover, therapeutic agents may induce an allergic reaction leading to interstitial inflammation and tubular damage. In this article, we present an updated version of the bibliography containing the case reports of nephrotoxicity published in the international literature from January 2003 to December 2004.
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Affiliation(s)
- Svetlana Karie
- Service de néphrologie, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75015 Paris, France.
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Grattagliano I, Portincasa P, Mastronardi M, Palmieri VO, Palasciano G. Esomeprazole-Induced Central Fever with Severe Myalgia. Ann Pharmacother 2005; 39:757-60. [PMID: 15741426 DOI: 10.1345/aph.1e377] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To report a case of central fever associated with severe myalgia following esomeprazole. CASE SUMMARY: A 64-year-old man presented with intense cephalalgia; severe, diffuse myalgia; and fever (>40°C) after esomeprazole initiation for treatment of gastritis. Five hours after ingestion of the first esomeprazole pill (40 mg), the patient developed fever associated with cephalalgia and myalgia. This condition lasted about 40 hours and disappeared spontaneously. Symptoms partially responded to acetaminophen. Four days later, the patient received a second dose of esomeprazole 40 mg. Subsequently, 4 hours later, fever (>40°C), headache, and difficulty in the movement of all parts of the body recurred. Neurologic examination was negative except for a minor state of disorientation. All reflexes were normal or slightly decreased. No skin lesions or breathing difficulty was noted. Routine blood tests were normal. Again, symptoms resolved spontaneously about 40 hours later. DISCUSSION: The temporal connection between esomeprazole intake and the onset of fever suggests a probable causal link, as confirmed by the Naranjo probability scale. However, the pathogenic mechanism remains unclear. Considering that esomeprazole is able to cross the blood—brain barrier, its peak serum concentration is reached 90–180 minutes after oral administration, and its serum half-life is approximately 2 hours, we assume that the appearance of fever with accompanying neurologic and muscular symptoms might result from the drug interference with the hypothalamic regulatory center of body temperature. CONCLUSIONS: Hyperpyrexia of central origin associated with intense cephalalgia and myalgia may occur as an adverse effect of esomeprazole therapy.
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Affiliation(s)
- Ignazio Grattagliano
- Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University Medical School of Bari, Bari, Italy.
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Geevasinga N, Kairaitis L, Rangan GK, Coleman PL. Acute interstitial nephritis secondary to esomeprazole. Med J Aust 2005; 182:235-6. [PMID: 15748135 DOI: 10.5694/j.1326-5377.2005.tb06675.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 12/02/2004] [Indexed: 11/17/2022]
Affiliation(s)
- Nimeshan Geevasinga
- Clinical School, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia.
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Abstract
Acute interstitial nephritis is an uncommon but important cause of acute renal failure. Proton pump inhibitors are now thought to be the most common class of drugs implicated in drug-induced acute interstitial nephritis. This is the first reported case of rabeprazole-induced acute interstitial nephritis.
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García García M, Illaro Uranga A, Aguirre Gómez C, Saracho Rotaeche R, Ruiz Osante B. Nefritis intersticial asociada a omeprazol. Descripción de un caso. FARMACIA HOSPITALARIA 2005; 29:147-8. [PMID: 16045430 DOI: 10.1016/s1130-6343(05)73653-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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