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Published: September 2011

Proton pump inhibitors and interstitial nephritis

Prescriber Update 32(3): 25
September 2011

CARM continues to receive reports of acute renal reactions, primarily interstitial nephritis, in association with the use of proton pump inhibitors (PPIs).

As of 30 June 2011, CARM had received a total of 65 reports of interstitial nephritis associated with omeprazole (62) and pantoprazole (3). The limited use of lansoprazole and esomeprazole in New Zealand may explain the lack of reports to CARM for these PPIs.

Patients with acute interstitial nephritis can present with the non-specific symptoms consistent with acute renal failure.1 Presenting symptoms include fever, rash, eosinophilia, malaise, myalgia, arthlargia, weight loss, altered urine output, blood or pus cells in the urine and/or high blood pressure.2,3 In some cases symptoms may also mimic those of vasculitis.4

In patients presenting with symptoms suggestive of interstitial nephritis the involvement of PPIs should be considered among a number of other risk factors. Other risk factors include: the use of β-lactams, NSAIDs, sulfonamides and diuretics; the presence of infection; and immune and neoplastic disorders.2,3

A definitive diagnosis of interstitial nephritis can only be confirmed with renal biopsy. If interstitial nephritis is suspected, urine microscopy and renal function should be assessed.

In cases of medicine-induced interstitial nephritis, the offending agent should be discontinued immediately and the patient referred to a renal physician for further assessment.

References
  1. Kodner C., Kudrimoti A. 2003. Diagnosis and management of acute interstitial nephritis. American Family Physician. 67(12): 2527-2534.
  2. Perazella M., Markowitz G. 2010. Drug-induced acute interstitial nephritis. Nature Reviews – Nephrology. 6:461-470.
  3. Medsafe. 2006. Proton pump inhibitors and interstitial nephritis. Prescriber Update. 27(1): 3.
  4. Personal communication. August 2011. Consultant Physician and Geriatrician. Wellington.

 

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