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Proton pump inhibitors and acute interstitial nephritis
Nimeshan Geevasinga1, Patrick L Coleman, Angela C Webster
1University of Sydney, Sydney, and Department of Medicine, Manly Hospital, Australia.
Summary
Proton pump inhibitors (PPIs) can cause acute interstitial nephritis (AIN) and acute renal failure (ARF). All available PPIs are implicated, suggesting a class effect that requires increased clinical awareness for prompt diagnosis and management.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Proton pump inhibitors (PPIs) are increasingly prescribed globally.
- Case reports suggest PPIs may cause acute interstitial nephritis (AIN) and acute renal failure (ARF).
Purpose of the Study:
- To determine the prevalence of PPI-induced AIN in Australia.
- To identify specific PPIs linked to AIN.
- To ascertain if AIN is a class effect of PPIs.
Main Methods:
- Retrospective case review at two teaching hospitals.
- Analysis of Therapeutic Goods Administration (TGA) of Australia registry data.
- Data collected included implicated PPI, concurrent medications, symptoms, and renal function parameters.
Main Results:
- 18 biopsy-proven cases of PPI-induced AIN causing ARF identified in the case review.
- TGA data revealed an additional 31 biopsy-proven AIN cases and other renal adverse events.
- All five commercially available PPIs were implicated in the reported cases.
Conclusions:
- PPI-induced AIN is likely to increase with widespread PPI use.
- Evidence suggests a class effect, implicating all available PPIs.
- Early recognition and management are crucial to prevent chronic kidney disease.