What is the appropriate workup for a 34-year-old male with impaired renal function, abdominal pain, and a history of Helicobacter (H.) pylori infection?

From the Guidelines

The appropriate workup for a 34-year-old male with impaired renal function, abdominal pain, and a history of Helicobacter (H.) pylori infection is to first confirm the presence of an active H. pylori infection using noninvasive tests such as the urea breath test (UBT) or stool antigen test [ 1 ].

Diagnostic Approach

• The patient's history of H. pylori infection and current symptoms suggest a possible recurrence or persistence of the infection, which may be contributing to his abdominal pain and impaired renal function.
• Noninvasive testing is preferred due to its ease of use and minimal risk of complications [ 1 ].
• The UBT and stool antigen test are both suitable options for detecting active H. pylori infection, but it is essential to note that these tests may be affected by recent use of antibiotics, bismuth, or proton pump inhibitors (PPIs), which can lead to false negative results [ 1 ].

Test Considerations

• If the patient has recently used any of these medications, it is recommended to wait at least 2 weeks before performing the UBT or stool antigen test to minimize the risk of false negative results [ 1 ].
• Histamine-2 receptor antagonists can be used as an alternative to PPIs, as they do not affect the bacterial load and will not interfere with the test results [ 1 ].
• If the results are negative, but there is still a high suspicion of active H. pylori infection, it may be necessary to repeat the test after a suitable interval to confirm the diagnosis [ 1 ].

From the Research

Appropriate Workup for Impaired Renal Function and H. pylori Infection

The workup for a 34-year-old male with impaired renal function, abdominal pain, and a history of Helicobacter (H.) pylori infection should consider the potential relationship between H. pylori infection and kidney damage.

• The patient's history of H. pylori infection is relevant, as studies have shown a possible link between H. pylori infection and kidney damage 2, 3.
• A study published in 2019 found that H. pylori infection may be a risk factor for kidney damage in patients with peptic ulcer, and that H. pylori eradication may benefit kidney damage relief and chronic kidney disease prevention 2.
• Another study published in 2017 found that the estimated prevalence of H. pylori infection among subjects with kidney disease was 53%, but did not support the association between H. pylori infection and non-dialysis-dependent kidney diseases nor CKD 3.
• The effects of H. pylori eradication on proteinuria levels have been investigated, with one study finding that eradication therapy may be effective in reducing proteinuria in patients with membranous nephropathy 4.
• When considering H. pylori eradication therapy in patients with decreased renal function, a systematic review recommended the use of a regimen with proton pump inhibitors (PPIs), clarithromycin, and metronidazole, or the combination of PPIs, clarithromycin, and amoxicillin at reduced doses depending on renal function 5.

Diagnostic Tests

The following diagnostic tests may be considered:

• 14C-urea breath test and rapid urease tests to detect H. pylori infection 2, 6.
• Random urine samples to examine the albumin-creatinine ratio (ACR) 2.
• Serum tests to detect the levels of IgA and underglycosylated IgA1 2.
• Urea breath test to evaluate H. pylori eradication rate 6.

Treatment

The treatment approach should consider the patient's impaired renal function and history of H. pylori infection.

• H. pylori eradication therapy may be recommended, with a regimen consisting of PPIs, clarithromycin, and metronidazole, or the combination of PPIs, clarithromycin, and amoxicillin at reduced doses depending on renal function 5.
• The patient's kidney function should be closely monitored during and after H. pylori eradication therapy 5.