Geevasinga Nimeshan, Coleman Patrick L, Webster Angela C, Roger Simon D
University of Sydney, Sydney, and Department of Medicine, Manly Hospital, Australia.
Clin Gastroenterol Hepatol. 2006 May;4(5):597-604. doi: 10.1016/j.cgh.2005.11.004.
BACKGROUND & AIMS: Proton pump inhibitors (PPIs) are a widely prescribed class of drugs, and their usage worldwide is increasing. Although well-tolerated, there have been case reports and a recent case series implicating these drugs in acute interstitial nephritis (AIN) and progression to acute renal failure (ARF). The aim of this study was to investigate how widespread this complication is in Australia, to identify which PPIs are implicated, and to establish whether PPI-induced AIN is a class effect.
We undertook a retrospective case review of potential cases at 2 teaching hospitals and a review of registry data from the Therapeutic Goods Administration of Australia (TGA). Parameters sought included the drug implicated, concurrent medications, symptoms, signs, serum creatinine, and time of onset after prescription.
We identified 18 cases of biopsy-proven PPI-induced AIN causing ARF in the retrospective case review, which is the largest hospital-based case series to date. The TGA registry data identified an additional 31 cases of "biopsy proven interstitial nephritis." An additional 10 cases of "suspected interstitial nephritis," 20 cases of "unclassified acute renal failure," and 26 cases of "renal impairment" were also identified. All 5 commercially available PPIs were implicated in these cases.
With the ever more widespread use of this class of medications, PPI-induced AIN is likely to become more frequent. There is now evidence to incriminate all the commercially available PPIs, suggesting there is a class effect. Failure to recognize this entity might have catastrophic long-term consequences including chronic kidney disease. Increased awareness might facilitate more rapid diagnosis and management of this potentially reversible condition.
质子泵抑制剂（PPIs）是一类广泛应用的处方药，其在全球的使用量正在增加。尽管耐受性良好，但已有病例报告以及最近的一系列病例表明这些药物与急性间质性肾炎（AIN）及进展为急性肾衰竭（ARF）有关。本研究的目的是调查这种并发症在澳大利亚的普遍程度，确定哪些质子泵抑制剂与之相关，并确定质子泵抑制剂诱导的AIN是否为类效应。
我们对两家教学医院的潜在病例进行了回顾性病例审查，并对澳大利亚治疗用品管理局（TGA）的注册数据进行了审查。所寻求的参数包括涉及的药物、同时使用的药物、症状、体征、血清肌酐以及处方后的发病时间。
在回顾性病例审查中，我们确定了18例经活检证实的质子泵抑制剂诱导的AIN导致ARF的病例，这是迄今为止最大的基于医院的病例系列。TGA注册数据又确定了31例“经活检证实的间质性肾炎”病例。还确定了另外10例“疑似间质性肾炎”、20例“未分类的急性肾衰竭”和26例“肾功能损害”病例。所有5种市售的质子泵抑制剂都与这些病例有关。
随着这类药物的使用越来越广泛，质子泵抑制剂诱导的AIN可能会变得更加常见。现在有证据表明所有市售的质子泵抑制剂都有问题，提示存在类效应。未能认识到这一情况可能会产生灾难性的长期后果，包括慢性肾病。提高认识可能有助于更快地诊断和管理这种潜在可逆的疾病。
