| アブストラクト | OBJECTIVE: Certain medications have been associated with drug-induced acute interstitial nephritis (AIN), but few prospective studies have been published. This prospective observational study aims to record and assess incidents of drug-induced AIN observed over a period of one year in nephrology units in France. The goal is to determine which medications are involved in AIN and to expound the clinical and biological presentation, management, and evolution of AIN. METHODS: Between April 2012 and April 2013, drug-associated cases of AIN were prospectively recorded in 24 patients registered in 11 nephrology units that belong to the Societe de Nephrologie de l'Ouest (SNO). Data sheets, including suspected and concomitant drug(s), kidney function assessment, biological disturbances, clinical signs, histological data, management, and evolution, were collected by the Rennes Regional Pharmacovigilance Center and recorded in the French pharmacovigilance database. RESULTS: In order, the most frequently involved medications in the AIN cases were: vitamin K antagonists (33.3% of the cases, almost exclusively fluindione), antibiotics (20.8% of cases) non-steroidal anti-inflammatory drugs (20.8% of cases), and proton pump inhibitors (16.7% of cases). The mean delay of onset to AIN was 8.3 weeks. At the time of diagnosis, mean serum creatinine was 366 muM, higher for vitamin K antagonists (VKAs), except in the case of warfarin. During the course of an AIN event, 70% of patients had complete blood count and/or urine analysis abnormalities, 55% had clinical signs of systemic hypersensitivity, and 13% of patients had hepatic disorders. Renal biopsies were performed in 54% of patients; however, only 37% of patients requiring therapeutic anticoagulation underwent a biopsy. Suspected drugs were discontinued in all patients and the majority was treated with oral corticosteroids. Renal function often continued to be impaired after an AIN event. At baseline, 25% of patients had chronic kidney disease (CKD); after an AIN event, 67% of patients were noted to have CKD. CONCLUSION: Physicians need to be aware of the possibility of drug-induced acute interstitial nephritis as a common cause of acute kidney injury (AKI). This study supports increased vigilance when prescribing three therapeutic classes frequently associated with AIN: antibiotics, NSAIDs and PPIs (especially in instances of polypharmacy), which were associated with two thirds of the AIN cases in this study. Fluindione, an oral anticoagulant exclusively marketed in Luxembourg and France where it constitutes the vast majority of VKA prescriptions, was associated with one third of the AIN cases alone, making it a common possible culprit of drug-induced AIN, warranting particular attention. |
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| ジャーナル名 | Presse medicale (Paris, France : 1983) |
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| 投稿日 | 2014/9/15 |
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| 投稿者 | Leven, Cyril; Hudier, Laurent; Picard, Sylvie; Longuet, Helene; Lorcy, Nolwenn; Cam, Gerard; Boukerroucha, Zakaria; Dolley-Hitze, Thibault; Le Cacheux, Philippe; Halimi, Jean-Michel; Cornec Le Gall, Emilie; Hanrotel-Saliou, Catherine; Arreule, Audrey; Massad, Michel; Duveau, Agnes; Couvrat-Desvergnes, Gregoire; Renaudineau, Eric |
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| 組織名 | Hopital Broussais, service de nephrologie, 35400 Saint-Malo, France.;Centre hospitalier universitaire de Rennes, service de pharmacovigilance, 35033;Rennes cedex 9, France.;Hopital Bretonneau, service de nephrologie, 37000 Tours, France.;Centre hospitalier universitaire de Rennes, service de nephrologie, 35033 Rennes;cedex 9, France.;Centre hospitalier universitaire de Poitiers, service de nephrologie, 86021;Poitiers, France.;Centre AUB sante, 35400 Saint-Malo, France.;Hopital Yves Le Foll, service de nephrologie, 22000 Saint-Brieuc, France.;Hopital de la Cavale Blanche, service de nephrologie, 29609 Brest, France.;Hopital de Girac, service de nephrologie, 16959 Angouleme, France.;Hopital Centre Bretagne, service de nephrologie, 56920 Noyal-Pontivy, France.;Hopital du Mans, service de nephrologie, 72000 Le Mans, France.;Centre hospitalier universitaire de Nantes, service de nephrologie, 44000 Nantes,;France.;Hopital Broussais, service de nephrologie, 35400 Saint-Malo, France. Electronic;address: e.renaudineau@ch-stmalo.fr. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/25218248/ |
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