Acute interstitial nephritis due to proton pump inhibitors
A 53-year-old female was admitted with a history of vomiting, loin pain for the 2 weeks and oliguria for 4 days. She was a known case of pulmonary tuberculosis who was receiving anti-tuberculosis therapy for the past 2 months. Pantoprazole was started for nausea 3 weeks ago. On examination, she appeared sick, febrile (100.5°F), tachypneic with a blood pressure of 130/80 mmHg. Blood urea was 76 mg/dl, serum creatinine 4.9 mg/dl and serum bicarbonate 14 mEq/L. She was started on daily hemodialysis for 4 days after which her general condition improved. Renal biopsy revealed AIN with dense lymphocyte and eosinophilic infiltrates in the interstitium []. PPI was stopped and she was started on oral corticosteroids for 8 weeks with continuation of anti-tuberculosis therapy. After 4 months her serum creatinine remained high at 1.6 mg/dl. Rifampicin induced AIN was considered unlikely given the temporal profile of events after start of pantoprazole and the fact that renal function rapidly recovered, after withdrawal of the latter with steroid therapy.