Desbuissons Geoffroy, Deray Gilbert, Mercadal Lucile
Service de néphrologie, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Service de néphrologie, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Nephrol Ther. 2018 Apr;14 Suppl 1:S115-S124. doi: 10.1016/j.nephro.2017.06.005. Epub 2017 Dec 20.
Assumed for a long time to be very well tolerated, proton pump inhibitors (PPIs) are widely prescribed for inpatients and outpatients; often beyond their validated indications. Nevertheless, many very varied side effects (pneumopathy, ischemic heart disease, dementia) have been associated with the PPIs during the last decade. Renal toxicity is mainly the occurrence of acute interstitial nephritis (AIN), related to a drug-class effect, involving cellular immunity. AINs, which occur especially in elderly patients, can be difficult to diagnose, with frequently isolated acute kidney injury, appearing with variable delay after the introduction of PPIs. Although sensitive to steroid therapy, patients frequently have an incomplete recovery of the kidney function. Very recently, the risk of chronic kidney disease (CKD) and the risk of progression of CKD among PPIs users have been well demonstrated in several large independent epidemiological studies. It is a low, but a significant side effect because of the millions of PPI prescriptions. Although further studies are needed to investigate the pathophysiological mechanisms leading the use of PPI to CKD, it is appropriate for the physicians to limit PPIs to their correct indications and to monitor renal function during these treatments.
长期以来，质子泵抑制剂（PPIs）被认为耐受性良好，在住院患者和门诊患者中广泛使用，且常常超出其已获验证的适应证范围。然而，在过去十年中，许多各种各样的副作用（肺病、缺血性心脏病、痴呆）都与PPIs有关。肾毒性主要表现为急性间质性肾炎（AIN），这与药物类别效应有关，涉及细胞免疫。AIN尤其在老年患者中出现，可能难以诊断，常伴有孤立的急性肾损伤，在开始使用PPIs后出现的延迟时间不一。尽管对类固醇治疗敏感，但患者的肾功能往往不能完全恢复。最近，在几项大型独立的流行病学研究中，PPIs使用者患慢性肾脏病（CKD）的风险以及CKD进展的风险已得到充分证实。这是一种低发生率但因数百万张PPI处方而显著的副作用。尽管需要进一步研究来探讨导致使用PPI引发CKD的病理生理机制，但医生应将PPIs的使用限制在正确的适应证范围内，并在这些治疗过程中监测肾功能。
