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Acute Interstitial Nephritis Due to Pantoprazole

Staff Pharmacist, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada

Sheldon W Tobe, FRCP(C)

Assistant Professor of Medicine, Nephrology, University of Toronto, Toronto; Division Director, Nephrology, Sunnybrook & Women's College Health Sciences Centre

Reprints: Sheldon W Tobe FRCP(C), Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Ave., Suite A240, Toronto, Ontario M4N 3M5, Canada, fax 416/480-6940, sheldon.tobe{at}sw.ca

OBJECTIVE: To describe what is believed, as of November 4, 2003, to be the first case published in the literature of acute interstitial nephritis (AIN) due to pantoprazole.

CASE SUMMARY: A 77-year-old white woman presented to the hospital with elevated serum creatinine, oliguria for the past 24 hours, arthralgia, fatigue, fever, and bilateral flank pain. The patient had initiated treatment with oral pantoprazole 40 mg/d for gastroesophageal reflux 2 months prior to admission. After 5 weeks of therapy, she stopped taking pantoprazole due to general malaise. Upon admission, all home medications, including pantoprazole, were reinitiated based on the patient's medication list. Serum creatinine increased to 6.1 mg/dL on day 4 of admission from a baseline of 1.0 mg/dL. Pantoprazole therapy was promptly discontinued, and prednisone 40 mg/d was initiated. Urinalysis revealed eosinophils, and a subsequent renal biopsy confirmed a diagnosis of AIN. The serum creatinine level gradually declined over 2 weeks, and the patient was discharged home with a serum creatinine level of 1.6 mg/dL. The Naranjo probability scale suggests a highly probable relationship between AIN and pantoprazole therapy in this patient.

DISCUSSION: Drug hypersensitivity reactions are the most common cause of AIN. There have been several reported cases of omeprazole-induced AIN. Although there are very few prospective data on the efficacy of treatment of drug-induced AIN, corticosteroids may have a role in recovery of renal function. Prednisone doses of 1 mg/kg/d have been suggested.

CONCLUSIONS: Physicians should be aware that drug-induced AIN can be associated with proton-pump inhibitors. Early detection of this rare adverse reaction may prevent acute renal insufficiency.

Key Words: acute interstitial nephritis, pantoprazole, renal failure

Published Online, December 5, 2003. www.theannals.com, DOI 10.1345/aph.1D085

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