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From: trigonometry1972 on 13 Sep 2007 06:22
Br J Clin Pharmacol. 2007 Jul 17; [Epub ahead of print]

Proton pump inhibitor-induced acute interstitial nephritis.

Härmark L, van der Wiel HE, de Groot MC, van Grootheest AC.

Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The
Netherlands.

What is already known about this subject * In several case reports the
use of
omeprazole has been associated with interstitial nephritis. * Recently
there have been reports linking other proton pump inhibitors (PPIs)
with interstitial
nephritis. What this study adds * We present supplementary cases
received by the Netherlands Pharmacovigilance Centre Lareb, concerning
interstitial nephritis in users of PPIs including omeprazole,
pantoprazole and rabeprazole. * In this case series seven patients are
presented. In six cases they recovered spontaneously after cessation
of the PPI, in one case the patient recovered after treatment with a
corticosteroid. * Further support for this association comes from the
worldwide adverse drug reaction database of the World Health
Organization. * This report shows that interstitial nephritis can
occur with all PPIs. Health professionals should be aware of this
potential serious adverse drug reaction. Aim To investigate the
association between the use of proton pump inhibitors (PPIs) and acute
interstitial nephritis (AIN). Methods The Netherlands
Pharmacovigilance Centre Lareb received seven case reports of AIN
induced by various PPIs. In five of the reports it was mentioned that
the diagnosis was confirmed by a renal biopsy. Results The time to
onset varied between hours to 4 months. In all cases but one the
patient spontaneously recovered after withdrawal of the offending
agent. In one case the patient received treatment with prednisolone
and recovered. In one patient a rechallenge was done 9 days after the
initial event. Within 12 h of re-exposure the patient developed
symptoms of AIN. Conclusions The mechanism of drug-induced AIN is
unknown, but an immunological mechanism is suspected. Our reports show
no relation between
dosage, latency, time to recovery, age or gender, supporting the
hypothesis that the aetiology of AIN is immunological. Lareb has
received reports of AIN with the use of omeprazole, pantoprazole and
rabeprazole. This shows that AIN is a complication associated with the
whole group of PPIs and not only omeprazole. It is important for
health professionals to be aware of this adverse drug reaction,
because an accurate and timely diagnosis and withdrawal of the
offending drug can prevent potentially life-threatening renal failure.

PMID: 17635502

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