A related commentary highlights the number of concerns that have been raised about adverse renal events and PPIs including hyponatremia, hypomagnesemia, calcineurin inhibitor–related drug interactions, and specifically, acute interstitial nephritis (AIN). Although only a small proportion of patients develop AIN from PPIs, the widespread and prolonged use of these drugs has made them one of the most common causes of drug-induced AIN in the developed world. The increase in CKD noted in this study is likely to be caused by undiagnosed and as a result, untreated PPI–induced AIN, which allows the inflammatory tubulointerstitial process to progress over time to chronic interstitial fibrosis.
The authors highlight that PPI use should be discouraged when a clear cut indication does not exist, and that in those who require PPI therapy to treat acid–related gastrointestinal disease, some form of surveillance (serum creatinine and/or urinalysis testing) should probably be undertaken PPI-induced AIN should be considered in patients with unexplained serum creatinine rise or urinalysis abnormalities, prompting nephrology consultation.