Acute tubulointerstitial nephritis and polyclonal hypergammaglobulinaemia: Which is the culprit?

  • Ana E. Sirvent | anaesipe@gmail.com Nephrology Section, Hospital General Universitario de Elche, Spain.
  • Ricardo Enríquez Nephrology Section, Hospital General Universitario de Elche, Spain.
  • Tania Muci Pathology Section, Hospital General Universitario de Elche, Spain.
  • Francisco Javier Ardoy-Ibañez Diagnostic Radiology Service, Hospital General Universitario de Elche, Spain.
  • Isabel Millán Nephrology Section, Hospital General Universitario de Elche, Spain.
  • Amadeo Almiñana Ophthalmology Section, Hospital General Universitario de Elche, Spain.
  • Rosalía Ruiz-Ferrús Nephrology Section, Hospital General Universitario de Elche, Spain.
  • Luis Jiménez del Cerro Nephrology Section, Hospital General Universitario de Elche, Spain.

Abstract

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.

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Published
2018-11-07
Section
Case Reports
Keywords:
Acute tubulointerstitial nephritis, hypergammaglobulinaemia, omeprazole, renal failure
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How to Cite
Sirvent, A. E., Enríquez, R., Muci, T., Ardoy-Ibañez, F., Millán, I., Almiñana, A., Ruiz-Ferrús, R., & del Cerro, L. (2018). Acute tubulointerstitial nephritis and polyclonal hypergammaglobulinaemia: Which is the culprit?. Clinics and Practice, 8(4). https://doi.org/10.4081/cp.2018.1065