Granulomatous tubulointerstitial nephritis secondary to omeprazole

Abstract

Drug-induced interstitial nephritis is a common cause of acute kidney injury indicated by elevated serum creatinine. We report a case of omeprazole-induced acute granulomatous interstitial nephritis (GIN). Our patient developed acute GIN secondary to omeprazole ingestion requiring haemodialysis. Treatment with steroids and withdrawal of omperazole was successful allowing the patient to discontinue haemodialysis in 3 months. She remains dialysis free with chronic kidney disease stage IV, reflected by a serum creatine of 191 μmol/L and estimated glomerular filtration rate of 23 mL/min/1.73 m2at 5 years on follow-up.

Granulomatous Interstitial Nephritis: A Rare Cause of Acute Kidney Injury

“…6 If granulomatous inflammation is present in a renal biopsy, the differential diagnosis include renal tuberculosis, renal sarcoidosis, drug-induced granulomatous interstitial nephritis, and tubulointerstitial nephritis and uveitis (TINU). 2 There are limited reports of GIN with NSAIDs; and antibiotics are presumed the most likely causative agents in our patient. Javaud et al found 7 out of 40 consecutive renal biopsies between January 1991 and February 2004 to have GIN that were considered druginduced.…”

“…Penicillins (ampicillin, oxacillin and methicillin) and cephalosporins have been linked to GIN in several case reports. 2,7 However, which of these two drugs was the culprit in our case, could not be determined as both can cause GIN as they share same histopathological patterns. When the cause of AKI remains unexplained, a renal biopsy is indicated for definitive diagnosis and management.…”

“…1 It can present with varying magnitudes of renal impairment and low-grade proteinuria, and can be severe enough to necessitate renal replacement therapy. 2 Treatment with a moderate dosage of prednisolone is associated with a good prognosis. 3 This present report describes this rare condition in an adult lady.…”

Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

“…Patient 2 was receiving nitrofurantoin, and patient 5 was on lisinopril medications that were described in rare case reports to cause GIN [21,22]. However, the 2 patients had been on these medications for many years without side effects; therefore, it is unlikely that they were responsible for GIN.…”

The relationship between proton pump inhibitors and renal disease

“… 8 PPIs are prescribed to treat gastric diseases such as gastric and duodenal ulcers, gastroesophageal reflux disease, and erosive esophagitis. 9 …”