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Proton pump inhibitors (PPIs) are widely prescribed to treat a number of gastrointestinal disorders due to excessive acid production. While effective and safe, adverse renal effects have been described. Most concerning is the ever increasing number of cases of acute interstitial nephritis (AIN) associated with PPI therapy. It appears to be a class effect as all PPIs have been documented to cause AIN. Several adverse drug event registries now note PPIs as the most common cause of drug-induced AIN. While most patients recover kidney function, many are left with some level of chronic kidney disease. Hyponatremia is an extremely rare complication and is thought to result from inappropriate ADH secretion. Interactions with calcineurin inhibitors may occur with certain PPIs when used in susceptible patients, particularly those with polymorphisms in the cytochrome P450-2C19 enzyme gene. This paper will critically review the effect of PPIs on the kidney.

Atazanavir is a new human immunodeficiency virus 1 protease inhibitor that has a favorable side-effect profile and is available in once-daily dosing. We report the case of a young man with human immunodeficiency virus infection who developed acute renal failure after therapy with this drug. Renal biopsy showed acute interstitial nephritis. This is the first report of acute interstitial nephritis from atazanavir.