Acute Tubulointerstitial Nephritis and Polyclonal Hypergammaglobulinaemia: Which Is the Culprit?

Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemi...

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Bibliographic Details
Published in:Clinics and practice 2018-11, Vol.8 (4), p.1065
Main Authors: Sirvent, Ana E., Enríquez, Ricardo, Muci, Tania, Ardoy-Ibañez, Francisco Javier, Millán, Isabel, Almiñana, Amadeo, Ruiz-Ferrús, Rosalía, del Cerro, Luis Jiménez
Format: Article
Language:English
Subjects:
Acute tubulointerstitial nephritis
Case Report
hypergammaglobulinaemia
omeprazole
renal failure
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Summary:Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemia and renal failure. After stopping omeprazole there was a partial improvement in serum creatinine and IgG. Renal biopsy revealed ATIN; immunohistochemistry for IgG4 was negative. Treatment with steroids and mycophenolate sodium improved renal function and normalized immunoglobulins. The lack of data of other entities and the patient’s evolution strongly point omeprazole as the culprit. After 27 months of follow-up, she remains clinical and analytically stable. ATIN caused by PPIs may appear after a long period of exposure and may be accompanied by analytical anomalies that simulate a systemic disease.
ISSN:2039-7283
2039-7275
2039-7283
DOI:10.4081/cp.2018.1065