Acute interstitial nephritis due to proton pump inhibitors
Our first index case was a 49-year-old female who was on follow-up for hypothyroidism, bronchial asthma, and acid peptic disease. She was taking omeprazole, eltroxin, deriphyllin for 8 weeks before being admitted with complaints of dysphagia and heart burn for 4 days. Here was no fever, loin pain or skin rash. Blood pressure was 140/80 mmHg. On admission, dipstick urinalysis showed 1+ protein and with 4-6 WBCs/hpf. Blood urea was 45 mg/dl and serum creatinine 1.6 mg/dl. Oliguria developed after 48 h and renal failure worsened. Renal ultrasonogram showed enlarged kidneys with increased cortical echoes. In renal biopsy the glomeruli were normal, but interstitium showed diffuse and dense lymphocytic infiltrates covering >90% of the core [].\nOmeprazole was stopped. She was treated with 10 mg/kg of intravenous methyl prednisolone for 3 days followed by oral prednisolone 1 mg/kg tapered to 0.5 mg/kg over 3 months. Her renal parameters gradually improved, but she is left with residual renal impairment with serum creatinine of 1.6 mg % after 1 year.