How the treatment of gastrointestinal tract disorders may be infl uenced by the kidneys

2021 ◽  
Vol 75 (5) ◽  
pp. 445-450
Author(s):  
Miroslav Merta

Summary: The treatment of gastrointestinal tract (GIT) diseases may, under specific conditions, be significantly influenced by the kidneys or by kidney disorders. One of the potential scenarios of such interaction is the concurrent involvement of the kidneys and the GIT organs within one disorder, another option being the negative impact of impaired renal function on the prognosis of the GIT disease and, finally, the need for an adequate choice and dose adjustment of renally eliminated medication to avoid nephrotoxicity. Renal impairment may occur as an adverse effect of the treatment of the GIT condition and may limit further therapy. In this context we have recently focused on the following clinical situations: the development of acute kidney injury during treatment with proton pump inhibitors, renal complications of inflammatory bowel disease management and the development of acute phosphate nephropathy due to the use phosphate containing laxatives. An early identification of the mechanisms leading to renal injury can prevent the development of irreversible renal lesions and facilitate an efficient treatment of the GIT. Key words: treatment of gastrointestinal tract disorders – acute kidney injury – proton pump inhibitors – renal complications of inflammatory bowel disease – acute phosphate nephropathy

2018 ◽  
Vol 154 (6) ◽  
pp. S-613
Author(s):  
Naomi R. Schwartz ◽  
Joseph A. Delaney ◽  
Helene Fevrier ◽  
Lisa J. Herrinton ◽  
Susan M. Hutfless ◽  
...  

2019 ◽  
Vol 24 (6) ◽  
pp. 489-496 ◽  
Author(s):  
Naomi R. M. Schwartz ◽  
Susan Hutfless ◽  
Lisa J. Herrinton ◽  
Laura B. Amsden ◽  
Helene B. Fevrier ◽  
...  

OBJECTIVES Evidence suggests use of proton pump inhibitors (PPIs) and H2 blockers may provoke disease flares in individuals with established inflammatory bowel disease (IBD); however, there are no studies investigating the relationship of these medications with risk of developing pediatric IBD. The hypothesis was that use of acid suppression therapy in children might be associated with development of pediatric IBD. METHODS This was a nested case-control study of 285 Kaiser Permanente Northern California members, age ≤21 years diagnosed with IBD from 1996 to 2016. Four controls without IBD were matched to each case on age, race, and membership status at the case's index date. Disease risk scores (DRS) were computed for each subject. Odds ratios and 95% confidence intervals were calculated by using conditional logistic regression models adjusted for DRS. RESULTS The children's mean age was 15.1 ± 2.6 years and 49.5% were female. Six cases (n = 3 Crohn's disease [CD], n = 3 ulcerative colitis [UC]) and 6 controls were prescribed PPIs and 10 cases (n = 7 CD, n = 3 UC) and 28 controls were prescribed H2 blockers. The OR for the association of at least 1 PPI or H2 blocker prescription with subsequent IBD was 3.6 (95% CI, 1.1–11.7) for PPIs and 1.6 (95% CI, 0.7–3.7) for H2 blockers. CONCLUSIONS Early-life PPI use appears to be associated with subsequent IBD risk. These findings have implications for clinical treatment of children with gastrointestinal symptoms and warrant further investigation in a larger cohort.


Author(s):  
Marques Joana Cristóvão ◽  
Barata Rui ◽  
Garcia Joana Lemos ◽  
Navarro David ◽  
Góis Mário ◽  
...  

Author(s):  
Majed Alghamdi ◽  
Yousef Abdali ◽  
Jamilah Alyami ◽  
Hala Aljohani ◽  
Majid Lughbi ◽  
...  

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041543
Author(s):  
Keiko Ikuta ◽  
Shunsaku Nakagawa ◽  
Kenji Momo ◽  
Atsushi Yonezawa ◽  
Kotaro Itohara ◽  
...  

ObjectivesThis study aimed to assess whether the combined use of proton pump inhibitors (PPIs) with non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics (penicillins, macrolides, cephalosporins or fluoroquinolones) was associated with an increased risk of acute kidney injury (AKI).DesignA nested case–control study.SettingA health insurance claims database constructed by the Japan Medical Data Center.ParticipantsPatients were eligible if they were prescribed a PPI, NSAID and antibiotic at least once between January 2005 and June 2017. The patients who were new PPI users and did not have any history of renal diseases before cohort entry were included (n=219 082). The mean age was 45 and 44% were women.InterventionsCurrent use of PPIs, NSAIDs, or antibiotics.Primary outcome measuresAcute kidney injury.ResultsDuring a mean follow-up of 2.4 (SD, 1.7) years, 317 cases of AKI were identified (incidence rate of 6.1/10 000 person-years). The current use of PPIs was associated with a higher risk of AKI compared with past PPI use (unadjusted OR, 4.09; 95% CI, 3.09 to 5.44). The unadjusted ORs of AKI for the current use of PPIs with NSAIDs, cephalosporins and fluoroquinolones, compared with the current use of PPIs alone, were 3.92 (95% CI, 2.40 to 6.52), 2.57 (1.43 to 4.62) and 3.08 (1.50 to 6.38), respectively. The effects of concurrent use of PPIs with NSAIDs, cephalosporins or fluoroquinolones remain significant in the adjusted model. The analyses on absolute risk of AKI confirmed the results from the nested case–control study.ConclusionsConcomitant use of NSAIDs with PPIs significantly increased the risk for AKI. Moreover, the results suggested that concomitant use of cephalosporins or fluoroquinolones with PPIs was associated with increased risk of incident AKI.


2021 ◽  
Vol 12 ◽  
Author(s):  
Eileen Haring ◽  
Robert Zeiser ◽  
Petya Apostolova

The intestine can be the target of several immunologically mediated diseases, including graft-versus-host disease (GVHD) and inflammatory bowel disease (IBD). GVHD is a life-threatening complication that occurs after allogeneic hematopoietic stem cell transplantation. Involvement of the gastrointestinal tract is associated with a particularly high mortality. GVHD development starts with the recognition of allo-antigens in the recipient by the donor immune system, which elicits immune-mediated damage of otherwise healthy tissues. IBD describes a group of immunologically mediated chronic inflammatory diseases of the intestine. Several aspects, including genetic predisposition and immune dysregulation, are responsible for the development of IBD, with Crohn’s disease and ulcerative colitis being the two most common variants. GVHD and IBD share multiple key features of their onset and development, including intestinal tissue damage and loss of intestinal barrier function. A further common feature in the pathophysiology of both diseases is the involvement of cytokines such as type I and II interferons (IFNs), amongst others. IFNs are a family of protein mediators produced as a part of the inflammatory response, typically to pathogens or malignant cells. Diverse, and partially paradoxical, effects have been described for IFNs in GVHD and IBD. This review summarizes current knowledge on the role of type I, II and III IFNs, including basic concepts and controversies about their functions in the context of GVHD and IBD. In addition, therapeutic options, research developments and remaining open questions are addressed.


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