Renal injury by administration of proton pump inhibitors

Proton pump inhibitors (PPIs) are widely applied for the acid-suppression treatment (۱). Their efficacy in remedying acid-related disorder processes is unique and their safety profile would be great. Despite this, some observational examinations suggest that their administration is related to a higher risk of several side health effects (۲). Especially, the consumption of PPIs has been correlated with an increased risk of Clostridium difficile infection (۳), development of dementia (۴), fractures of the hip and spine (۵), hypomagnesemia (۶) and the community-acquired pneumonia (۷). Similarly, PPIs consumption is also related with a higher risk of acute renal injury, acute interstitial nephritis (AIN), chronic kidney disease (CKD), and end-stage renal disease (ESRD) (۸,۹). This paper will focus on PPIs’ side effects on kidney.In ۱۹۹۸, Donna and colleagues showed that AIN could be the cause of acute kidney injury (۱۰). After that, in ۱۹۹۲, Stephen and colleagues described that PPIs might be a reason of acute interstitial nephritis (۱۱), with many case articles (۱۲,۱۳). Moreover, acute interstitial nephritis induced by PPIs is often without usual allergic signs, making it challengeable for physicians to readily recognize the problem. Furthermore, a recent examination exhibited that only about one quarter of patients were suspected to have PPI-induced acute interstitial nephritis (۱۴). PPI-induced AIN is usually detected in the late phases of disease, which might be manifested weeks to months after drug initiation, may lead to the development of chronic interstitial fibrosis (۱۴). Thus, PPI-induced acute interstitial nephritis should be considered in cases with urinalysis abnormalities or unexplained serum creatinine increment, prompting to a nephrology consultation and perhaps, kidney biopsy to confirm acute interstitial nephritis (۱۵).In ۲۰۱۶, Benjamin and colleagues prospectively reported that PPIs consumers may also present a significantly greater risk of CKD than non-consumers; which it was discovered among ۱۰,۴۳۹ patients for a period of ۱۳.۹ years in the atherosclerosis risk in communities (ARIC) survey (۸). Generally, PPIs may be responsible for a very low proportion of acute interstitial nephritis; however, their association with CKD does not seem to be notable, while presence of higher proportion of other comorbid disorders and other medications may also be responsible of chronic renal failure in these patients (۱۶).PPIs are using by millions of people worldwide (۱۵). Generally, they have an excellent overall care profile. In spite of this, many concerns have been enhanced about kidney side effects, consisted of hypomagnesemia, hyponatremia, acute interstitial nephritis, and specifically chronic kidney disease over time (۱۷) (Table ۱).Hence, it is important that physicians who may recommend these medications, should be aware of both the short-term AIN risk as well as the long-term chronic renal failure risk.This article has briefly focused on the fact that PPIs may have some side effects on the kidney, and worldwide, physicians should be aware of their side effects, considering them in any person taking PPIs.

کلیدواژه ها:

Proton pump inhibitors ، Acute renal injury ، Acute interstitial nephritis ، Chronic kidney disease ، End-stage renal disease ، Acute kidney injury