ABSTRACT

Introduction: Proton pump inhibitors are used very commonly for gastrointestinal prophylaxis in hospitalized patients. They become part of long list of medications used by older patients, who usually have multiple comorbidities and are on multiple medications. If they develop acute kidney injury, it is often difficult to identify the etiology.

Case Report: An 80-year-old female on multiple medications presented with weakness, decrease in urine output, and rash. She was on pantoprazole for a long time due to many hospital admissions and continued taking it in between admissions. Previous admission kidney biopsy showed acute interstitial nephritis (AIN). Acute kidney injury (AKI) improved with steroid therapy. Antibiotics and furosemide were identified as likely cause of AKI, but pantoprazole was not suspected and was continued. Pantoprazole was held current admission, and was treated with steroids again with improvement in creatinine (Cr) to 2.2 mg/dL from 3.9 mg/dL in three weeks.

Conclusion: Proton pump inhibitors (PPIs) are frequently used for prophylaxis in hospitalized patients and continued upon discharge. Proton pump inhibitors are an important cause of AIN and important cause of chronic kidney disease. During discharge of hospitalized patients and post-discharge visit, indication for use of PPIs should be looked at carefully. Histamine blockers may be used, if needed for gastrointestinal prophylaxis.