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[Proton pump inhibitors and kidney].

Geoffroy Desbuissons1, Gilbert Deray1, Lucile Mercadal1

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Proton pump inhibitors (PPIs) are linked to kidney damage, including acute interstitial nephritis and chronic kidney disease. Physicians should limit PPI use to appropriate indications and monitor kidney function.

Keywords:
Acute interstitial nephritisAcute kidney injuryChronic kidney diseaseDrug toxicityInhibiteur de la pompe à protonsInsuffisance rénale aiguëInsuffisance rénale chroniqueNéphrite interstitielle aiguëProton pump inhibitorToxicité médicamenteuse

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Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Proton pump inhibitors (PPIs) are widely prescribed but associated with various side effects.
  • Renal toxicity, primarily acute interstitial nephritis (AIN), is a known concern, particularly in elderly patients.
  • Recent studies highlight the risk of chronic kidney disease (CKD) and CKD progression with PPI use.

Purpose of the Study:

  • To summarize the renal side effects associated with proton pump inhibitors.
  • To emphasize the diagnostic challenges and treatment outcomes of PPI-induced AIN.
  • To discuss the recently established risks of CKD and CKD progression linked to PPIs.

Main Methods:

  • Review of recent epidemiological studies and clinical data on PPI-associated renal toxicity.
  • Analysis of drug-class effects and immune mechanisms in AIN.
  • Evaluation of the incidence and progression of CKD in PPI users.

Main Results:

  • PPIs are associated with acute interstitial nephritis (AIN), a drug-class effect involving cellular immunity, often presenting as isolated acute kidney injury.
  • AIN diagnosis can be challenging, especially in the elderly, and kidney function recovery is frequently incomplete despite steroid therapy.
  • Large epidemiological studies confirm a significant risk of developing and progressing chronic kidney disease (CKD) with PPI use, despite a low individual risk.

Conclusions:

  • Physicians should judiciously prescribe PPIs, adhering to validated indications.
  • Monitoring renal function in patients on long-term PPI therapy is crucial.
  • Further research is needed to elucidate the mechanisms linking PPIs to CKD.