Drug-induced tubulo-interstitial nephritis secondary to proton pump inhibitors: experience from a single UK renal unit

Abstract

Drugs are the most common cause of interstitial nephritis in the population studied. Those drugs most commonly associated with interstitial nephritis were the proton pump inhibitors omeprazole and lansoprazole.

Effect of proton pump inhibitors on gastric pH in patients exposed to severe stress

“…Despite a dearth of clinical studies in critically ill patients [8], many ICUs are now using PPI to prevent stress-related GI bleeding. The onset of action of PPIs has been shown to be quite rapid.…”

“…Recently, it was shown that gastric acid suppression therapy was also associated with an increased risk of community-acquired pneumonia [7]. Moreover, PPIs are an important cause of drugassociated tubulointerstitial nephritis [8] and have been linked to increased risk of enteric infections including Clostridium difficile-associated diarrhea [9]. Therefore, the use of PPIs should be carefully considered for each patient.…”

Proton Pump Inhibitors and Acute Interstitial Nephritis

“…Studies suggest that AIN is the cause of 6%-8% of episodes of acute renal failure (ARF). 11,12 The diagnosis of AIN seems to be most prevalent in renal biopsies in which there is unexplained renal impairment in the presence of an inactive urinary sediment, ie, lack of heavy proteinuria, significant hematuria, or presence of dysmorphic red blood cells. In this setting AIN has been reported to occur in as many as 25% of cases.…”

Medicinal Mishap: Interstitial nephritis associated with omeprazole

“…The duration of proton pump inhibitor treatment before presentation is usually between two weeks and nine months. 4 The temporal relationship in this case suggests that omeprazole was the most likely cause of interstitial nephritis, although the possibility that amoxycillin, pantoprazole or the NSAID were implicated cannot be excluded.…”