avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2017-7-6-415-422avk-716Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESПОЧЕЧНАЯ БЕЗОПАСНОСТЬ ИНГИБИТОРОВ ПРОТОННОЙ ПОМПЫRENAL SAFETY OF PROTON PUMP INHIBITORSДядыкА. И.DyadykA. I.

 кафедра терапии ФИПО.

Донецк.

Department of Therapy, Faculty of postgraduated education.

Donetsk

КуглерТ. Е.KuglerT. E.

 кафедра терапии ФИПО.

Донецк.

Department of Therapy, Faculty of postgraduated education.

Donetsk

kugler2@mail.ruДонецкий Национальный медицинский университет им. Максима Горького.УкраинаM. Gorky Donetsk National Medical University.Ukraine20171012201776415422Copyright © Дядык А.И., Куглер Т.Е., 20172017Дядык А.И., Куглер Т.Е.Dyadyk A.I., Kugler T.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/716

Ингибиторы протонной помпы широко используются в клинической практике и принимаются миллионами пациентов во всем мире в течение длительного периода времени. Несмотря на то, что ингибиторы протонной помпы считаются классом препаратов с хорошим профилем безопасности, растет число публикаций об их ренальных побочных эффектах, включающих развитие острого тубулоинтерстициального нефрита. Тубулоинтерстициальный нефрит является одной из ведущих причин развития острого повреждения почек, а следовательно ассоциируется с неблагоприятным прогнозом и возможной хронизацией патологического процесса, обозначаемого как хроническая болезнь почек. В данном обзоре рассмотрены эпидемиология, патогенетические варианты развития, критерии диагностики (в том числе оценка морфологической картины), клинические проявления и лечение острого тубулоинтерстициального нефрита, индуцированного приемом ингибиторов протонной помпы. Как правило, для него характерно субклиническое течение без классических проявлений реакции гиперчувствительности замедленного типа: лихорадки, кожной сыпи, эозинофилии, артралгий. Повышение уровня сывороточного креатинина, снижение скорости клубочковой фильтрации, электролитные нарушения, патологические изменения в анализах мочи не являются высоко специфичными показателями, но позволяют с высокой долей вероятности предположить у больного развитие острого тубулоинтерстициального нефрита. «Золотым» стандартом диагностики является прижизненное морфологическое исследование почек. Своевременная диагностика и незамедлительная отмена ингибиторов протонной помпы является первоочередными лечебными подходами при персистенции клинических проявлений острого тубулоинтерстициального нефрита. Назначение ингибиторов протонной помпы должно проводиться только по строгим показаниям с соблюдением оптимальной продолжительности лечения и обязательным контролем состояния функции почек. Обязательно следует учитывать наличие сопутствующих заболеваний пациента, которые служат дополнительными факторами нефротоксичности (пожилой возраст, сердечная недостаточность, сахарный диабет, цирроз печени, хроническая болезнь почек, гиповолемические состояния). Привлечение внимания многопрофильных специалистов к проблеме развития острого тубулоинтерстициального нефрита, индуцированного приемом ингибиторов протонной помпы, улучшит раннюю диагностику и лечение данного заболевания.

Proton pump inhibitors are a widely used in clinical practice, and are taken by millions of patients around the world for a long time. While proton pump inhibitors are well-tolerated class of drugs, the number of publications has been raised about adverse renal effects, specially their association with acute tubulointerstitial nephritis. It is one of the leading causes of acute renal injury and have catastrophic long-term consequences called chronic kidney disease. In this review, we consider epidemiology, pathogenesis, diagnostic criteria (including biopsy and morphological pattern), clinical manifestations and treatment of proton pump inhibitors-induced acute tubulointerstitial nephritis. A subclinical course without classical manifestations of a cell-mediated hypersensitivity reaction (fever, skin rash, eosinophilia, arthralgia) is characteristic of acute tubulointerstitial nephritis. Increased serum creatinine, decreased glomerular filtration rate, electrolyte disorders, pathological changes in urine tests are not highly specific indicators, but allow to suspect the development of acute tubulointerstitial nephritis. The “gold” standard of diagnosis is the intravital morphological examination of the kidney tissue. Timely diagnosis and immediate discontinuation of the potentially causative drug is the mainstay of therapy and the first necessary step in the early management of suspected or biopsy-proven drug-induced acute tubulointerstitial nephritis. The usage of proton pump inhibitors should be performed only on strict indications with optimal duration of treatment and careful monitoring of kidney function. Multiple comorbidities (older age, heart failure, diabetes, cirrhosis, chronic kidney disease, hypovolemia) increase potential nephrotoxicity. Awareness of this iatrogenic complication will improve diagnosis of proton pump inhibitors-induced acute tubulointerstitial nephritis by multidisciplinary specialists and increase the possibility of successful treatment.

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The authors declare that there are no conflicts of interest present.