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Nefrite intersticial aguda induzida por inibidores da bomba de protões : artigo de revisão com caso clínico
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A nefrite intersticial aguda (NIA) é uma doença pouco frequente, caracterizada pela presença de infiltrado inflamatório no interstício renal. É precipitada, mais frequentemente, por medicamentos, estando também associada a outras causas. Os inibidores da bomba de protões (IBPs) são dos fármacos mais utilizados a nível mundial. Apesar de bem tolerados, têm sido documentados alguns casos de indução de NIA. Com o aumento do uso dos IBPs é provável que a incidência da NIA induzida por este fármaco venha também a aumentar.
As manifestações clínicas da doença associam-se à lesão renal aguda (LRA) subjacente, não havendo sinais, sintomas ou achados laboratoriais que permitam distinguir a NIA de outras causas de LRA. O gold standard para o diagnóstico é a biopsia renal.
A terapêutica com corticosteroides permanece controversa, mas sabe-se que para evitar a progressão da LRA é necessário a rápida suspensão do fármaco. É, por isso, necessário existir um alto nível de suspeição por parte dos médicos para exercerem um correto e atempado diagnóstico.
Com base na recolha e interpretação de vários artigos e estudos referentes a casos clínicos identificados no passado pretende-se fazer uma revisão da doença com recurso à exemplificação de um caso clínico.
Acute interstitial nephritis (AIN) is a rare disease, which presents itself with inflammatory infiltrations within the kidney interstitium. It’s frequently precipitated by drugs, but also by other causes. Proton pump inhibitors (PPI) are highly prescribed worldwide. Generally they are well tolerated, but there have been some cases of induced AIN. With the increased use of the PPIs it’s probable that the incidence of the disease will also increase. The clinical and biological manifestations of the disease are associated to the underlying acute kidney injury (AKI). There are no clinical or analytic findings that allow the differentiation between AIN from other causes of AKI. Kidney biopsy remains the golden standard for diagnosis. Treatment with corticosteroids remains controversial. But it’s known that quick removal of the precipitating agent is absolutely necessary to avoid AKI. Therefore, it’s essential the existence of a high level of suspicion from medical practitioners to make a correct and fast diagnosis. Based on the gathering and interpretation of various articles and studies related to passed clinical cases, this paper intends to do a review of the disease and use as an example an actual and real clinical case.
Acute interstitial nephritis (AIN) is a rare disease, which presents itself with inflammatory infiltrations within the kidney interstitium. It’s frequently precipitated by drugs, but also by other causes. Proton pump inhibitors (PPI) are highly prescribed worldwide. Generally they are well tolerated, but there have been some cases of induced AIN. With the increased use of the PPIs it’s probable that the incidence of the disease will also increase. The clinical and biological manifestations of the disease are associated to the underlying acute kidney injury (AKI). There are no clinical or analytic findings that allow the differentiation between AIN from other causes of AKI. Kidney biopsy remains the golden standard for diagnosis. Treatment with corticosteroids remains controversial. But it’s known that quick removal of the precipitating agent is absolutely necessary to avoid AKI. Therefore, it’s essential the existence of a high level of suspicion from medical practitioners to make a correct and fast diagnosis. Based on the gathering and interpretation of various articles and studies related to passed clinical cases, this paper intends to do a review of the disease and use as an example an actual and real clinical case.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Nefrite intersticial Inibidores da bomba de prótons Nefrologia