Proton pump inhibitor-induced acute interstitial nephritis

What is already known about this subject

• In several case reports the use of omeprazole has been associated with interstitial nephritis.
• Recently there have been reports linking other proton pump inhibitors (PPIs) with interstitial nephritis.

What this study adds

• We present supplementary cases received by the Netherlands Pharmacovigilance Centre Lareb, concerning interstitial nephritis in users of PPIs including omeprazole, pantoprazole and rabeprazole.
• In this case series seven patients are presented. In six cases they recovered spontaneously after cessation of the PPI, in one case the patient recovered after treatment with a corticosteroid.
• Further support for this association comes from the worldwide adverse drug reaction database of the World Health Organization.
• This report shows that interstitial nephritis can occur with all PPIs. Health professionals should be aware of this potential serious adverse drug reaction.

Aim

To investigate the association between the use of proton pump inhibitors (PPIs) and acute interstitial nephritis (AIN).

Methods

The Netherlands Pharmacovigilance Centre Lareb received seven case reports of AIN induced by various PPIs. In five of the reports it was mentioned that the diagnosis was confirmed by a renal biopsy.

Results

The time to onset varied between hours to 4 months. In all cases but one the patient spontaneously recovered after withdrawal of the offending agent. In one case the patient received treatment with prednisolone and recovered. In one patient a rechallenge was done 9 days after the initial event. Within 12 h of re-exposure the patient developed symptoms of AIN.

Conclusions

The mechanism of drug-induced AIN is unknown, but an immunological mechanism is suspected. Our reports show no relation between dosage, latency, time to recovery, age or gender, supporting the hypothesis that the aetiology of AIN is immunological. Lareb has received reports of AIN with the use of omeprazole, pantoprazole and rabeprazole. This shows that AIN is a complication associated with the whole group of PPIs and not only omeprazole. It is important for health professionals to be aware of this adverse drug reaction, because an accurate and timely diagnosis and withdrawal of the offending drug can prevent potentially life-threatening renal failure.     

Clinical and electrophysiological characteristics of peripheral neuropathy in Cuban systemic lupus erythematosus patients

BackgroundPeripheral neuropathy (PN) is one of the most heterogeneous and poorly understood or characterized manifestations in systemic lupus erythematosus (SLE). The aim of this study was to describe the clinical and electrophysiological features, and neuropathic disease associations, in Cuban SLE patients.Patients and methodsOne hundred and two consecutive SLE patients admitted to the Psychoneuroimmunology service at the National Institute of Nephrology were included in the study. Patients with other disorders known to cause neuropathy were excluded. Demographic, clinical and laboratory data were obtained using a pre-defined questionnaire. Nerve conduction studies were carried out in both upper and lower limbs. Neuropathy was defined as the presence of clinical symptoms and/or signs and bilateral abnormal nerve conduction study parameters.ResultsThe 102 patients were 99 females and 3 males with mean age of 46 ± 12 years and disease duration 8 ± 9 years. PN was found in 55/102 (53.9%) patients; 48 (87.3%) had clinical peripheral neuropathy manifestations and 7 (12.7%) were asymptomatic. Nerve conduction studies suggested asymmetric axonal-demyelination neuropathy pattern. Mixed sensory-motor neuropathy was the most common involvement in 23(41.8%) cases. The most frequent pattern was polyneuropathy. Compared to those without neuropathy, SLE-related polyneuropathy patients were significantly older, but had no other significant associations with demographic, disease duration or serological/immunological data.ConclusionPeripheral nervous system manifestations are common in SLE; may be related to an increased susceptibility of peripheral nerves to effects of aging. Nerve conduction studies are recommended, therefore, for inclusion in the follow-up of SLE patients especially in the older population.     

狼疮性肾炎临床指南和共识的方法学质量评价

目的系统评价狼疮性肾炎临床指南和共识的方法学质量,并收集指南相关推荐意见,为临床决策提供参考依据。方法计算机检索PubMed、CNKI、CBM数据库及NGC、NICE、GIN、SIGN和医脉通等相关网站,搜集狼疮性肾炎临床指南和专家共识,检索时限均从2012年1月至2020年12月。由4名评价员经一致性评价后,使用AGREEⅡ工具对纳入指南或专家共识进行方法学质量评价,并汇总各指南在狼疮性肾炎治疗方面的相关推荐意见及证据等级、推荐强度等。结果共纳入8篇指南和2篇共识。其中,8篇指南或共识为B级指南(一般推荐),2篇为C级指南(不推荐)。相关推荐意见主要按照狼疮性肾炎的病理类型给出了相应的治疗方案。结论我国狼疮性肾炎指南的方法学质量尚需提高,纳入的10篇指南和共识可为临床决策者提供一定参考,但未来需要制订更高质量的针对我国狼疮性肾炎人群的临床实践指南。     

Subacute cutaneous lupus erythematosus and life-threatening hypokalaemic tetraparesis: a rare complication

We describe a patient with lesions of subacute cutaneous lupus erythematosus associated with high titres of anti‐Ro and anti‐La antibodies who developed a rapidly progressive flaccid tetraparesis due to profound hypokalaemia. After investigation she was found to have distal renal tubular acidosis (dRTA) without pathological evidence of lupus nephritis. It is likely that her dRTA was a manifestation of associated Sjögren’s syndrome, which had been otherwise asymptomatic. This is the first report of such a complication in the dermatological literature.     

A case of nodular cutaneous lupus mucinosis

The patient was a 44-year-old female. She was diagnosed as having systemic lupus erythematosus at the age of 21 years and had been receiving systemic steroid treatment (5 mg prednisolone/day). Nodules began to appear on her neck, chest and back from June in 2000, and she was referred to our clinic for examination and treatment. Examination of a biopsy sample of an eruption on the neck revealed mucin deposition in the dermis. Based on the clinical and histopathological findings, she was diagnosed as having typical nodular cutaneous lupus mucinosis. The dose of steroid was increased, and the eruptions gradually disappeared.     

系统性红斑狼疮患者的血液学异常及治疗

目的:探讨系统性红斑狼疮(SLE)患者的血液学异常变化及其对药物治疗的反应。方法:对142例SLE患者外周血、骨髓象及应用糖皮质激素、免疫抑制剂治疗后变化情况进行总结分析。结果:142例中血象异常者121例,以血液学异常为首发症状就诊者32例(26.45%),其中误诊为血液系统疾病9例(7.44%)。在142例中45例行骨髓细胞学检查,发现骨髓增生活跃或明显活跃35例(77.78%),增生低下者10例(22.22%)。结论:SLE易累及血液系统,其特点是血液学改变多样性,缺乏特异性,容易误诊漏诊。SLE患者经糖皮质激素及免疫抑制剂治疗,其外周血和骨髓象均有不同程度的改善。     

狼疮性肾炎患者内皮细胞蛋白C受体表达的研究

目的探讨内皮细胞蛋白C受体(EPCR)与系统性红斑狼疮(SLE)并发狼疮性肾炎(LN)的关系。方法采用酶联免疫吸附试验(ELISA)和反向聚合酶链反应(RT-PCR)技术分别对SLE患者和并发LN的SLE患者血浆中可溶性EPCR(sEPCR)水平和外周血循环系统内皮细胞蛋白C受体mRNA的表达进行检测。结果SLE患者的sEPCR平均水平(261±13ng/ml)比正常对照组的sEPCR平均水平(167±11ng/ml)明显增高(P<0.001);并发LN的SLE患者sEPCR水平(312±21ng/ml)比LN的SLE患者的sEPCR平均水平(261±13ng/ml)明显增高(P<0.001)。SLE患者组(132.5±32.6mg/L)及并发LN的SLE患者组(201±33.5mg/L)的EPCRmRNA表达均明显高于正常对照组(88.6±29.5mg/L)的EPCRmRNA表达(P<0.005),且SLE患者组与并LN的SLE患者组间EPCRmRNA表达有显著性差异(P<0.005)。结论外周血循环系统EPCR升高可能是一个早期发现LN的标志物,EPCR在狼疮性肾炎发病中可能发挥重要作用。