RESUMO
Rhabdomyolysis is a rare but well-known complication of statin therapy. The risk is considerably increased when concomitant drugs are administered that inhibit metabolism and breakdown via the cytochrome CYP3A4. We report a case of myoglobin-induced acute renal failure secondary to the concomitant use of simvastatin and amiodarone. The risk of rhabdomyolysis is mainly determined by the statin dose; in the case of the concomitant use of CYP3A4 inhibitors, a maximal daily dose of 20 mg is recommended to avoid harmful drug interactions.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/urina , Amiodarona/efeitos adversos , Inibidores Enzimáticos/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Mioglobinúria/urina , Sinvastatina/efeitos adversos , Idoso , Interações Medicamentosas , Humanos , Masculino , Terapia de Substituição Renal , Rabdomiólise/induzido quimicamente , Choque Séptico/complicações , Choque Séptico/tratamento farmacológicoRESUMO
INTRODUCTION: Neurologic and muscular damage associated with acute hepatitis due to hepatitis E virus (HEV) are rare and may be underdiagnosed. CASE REPORT: We report the case of a 56-year-old man, presenting with flaccid tetraparesis secondary to an acute rhabdomyolysis induced by acute E virus hepatitis. He fully recovered after one month under supportive treatment. DISCUSSION: Rare cases of acute rhabdomyolysis induced by HEV infection have been reported in the literature. We discuss the potential adjuvant role of statin treatment in our patient. Unexplained acute neurological conditions should prompt the search for HEV infection.
Assuntos
Vírus da Hepatite E , Hepatite E , Inibidores de Hidroximetilglutaril-CoA Redutases , Rabdomiólise , Hepatite E/complicações , Hepatite E/diagnóstico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Masculino , Pessoa de Meia-Idade , Rabdomiólise/induzido quimicamente , Rabdomiólise/complicações , Rabdomiólise/diagnósticoRESUMO
CME/Answers: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis Abstract. Elevated CK values with or without symptoms require clarification in order to rule out possible secondary complications. Adequate hydrogenation, discontinuation of possibly triggering drugs and noxious agents, and close laboratory controls are decisive for the outcome. Acute rhabdomyolysis can have various causes, which can generally be classified as traumatic or atraumatic. In case of recurrent occurrence, genetic or autoimmunological diseases must also be excluded. In addition to a detailed anamnesis, physical examination, laboratory and urine tests, a variety of diagnostic methods are available, which should be used selectively. The aim of this work is to address possible clarification strategies, causes and differential diagnoses of an increase in creatine kinase and rhabdomyolysis. We illustrate these with a case.
Assuntos
Injúria Renal Aguda , Rabdomiólise , Injúria Renal Aguda/diagnóstico , Creatina Quinase , Diagnóstico Diferencial , Humanos , Exame Físico , Rabdomiólise/diagnóstico , Rabdomiólise/etiologiaRESUMO
CME: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis Abstract. Elevated CK values with or without symptoms require clarification in order to rule out possible secondary complications. Adequate hydrogenation, discontinuation of possibly triggering drugs and noxious agents, and close laboratory controls are decisive for the outcome. Acute rhabdomyolysis can have various causes, which can generally be classified as traumatic or atraumatic. In case of recurrent occurrence, genetic or autoimmunological diseases must also be excluded. In addition to a detailed anamnesis, physical examination, laboratory and urine tests, a variety of diagnostic methods are available, which should be used selectively. The aim of this work is to address possible clarification strategies, causes and differential diagnoses of an increase in creatine kinase and rhabdomyolysis. We illustrate these with a case.
Assuntos
Injúria Renal Aguda , Rabdomiólise , Creatina Quinase , Humanos , Rabdomiólise/diagnóstico , Rabdomiólise/etiologiaRESUMO
INTRODUCTION: Acute muscle involvement is an infrequent complication of corticosteroids, characterized by muscle weakness and a rhabdomyolysis, rapidly regressive after withdrawal of corticosteroids. CASE REPORT: We report the case of a woman admitted in intensive care unit for acute severe asthma, treated with high doses of methylprednisolone. Serum CPK level raised with a peak at 28,160 UI/L (n<250 UI/L) at day 15, suggesting acute rhabdomyolysis with renal failure. CPK rapidly normalized when corticosteroids were discontinued. Other causes of rhabdomyolysis were ruled out. CONCLUSION: This necrosing myopathy under high doses of corticosteroids has been described in patients with severe acute asthma. The mechanism of the muscle damage results from a combination of corticosteroids toxicity, respiratory acidosis and mechanic ventilation.
Assuntos
Corticosteroides/efeitos adversos , Asma/tratamento farmacológico , Rabdomiólise/induzido quimicamente , Doença Aguda , Corticosteroides/uso terapêutico , Asma/patologia , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Rabdomiólise/diagnóstico , Índice de Gravidade de DoençaRESUMO
The introduction of lenalidomide into the therapeutic arsenal of hematologic malignancies has represented an important step forward in the management of multiple myeloma. However, its use is associated with several toxicities including kidney injury. The present review examines the drug's pharmacokinetics, discusses the main adverse renal effects that are associated with lenalidomide treatment, and makes recommendations for dosage adjustment in patients with underlying renal impairment.
Assuntos
Fatores Imunológicos/efeitos adversos , Rim/efeitos dos fármacos , Insuficiência Renal , Talidomida/análogos & derivados , Doença Enxerto-Hospedeiro/induzido quimicamente , Doença Enxerto-Hospedeiro/imunologia , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/farmacocinética , Rim/patologia , Túbulos Renais/efeitos dos fármacos , Túbulos Renais/patologia , Lenalidomida , Necrose/induzido quimicamente , Nefrite Intersticial/induzido quimicamente , Prevalência , Insuficiência Renal/epidemiologia , Insuficiência Renal/metabolismo , Talidomida/administração & dosagem , Talidomida/efeitos adversos , Talidomida/farmacocinéticaRESUMO
The Drug rash with hypereosinophilia and systemic symptoms (DRESS) syndrome, or hypersensitivity syndrome, is a severe drug-induced hypersensitivity syndrome. It has been exceptionally described with ciprofloxacin. We report a 47-year-old-woman who developed DRESS syndrome, 2 days after taking ciprofloxacin for a urinary infection. She had a generalized maculopapular rash, severe rhabdomyolysis, liver involvement, renal failure and hypereosinophilia. Clinical symptoms had completely resolved after ciprofloxacin withdrawal. Renal failure has decrease after short corticosteroid treatment.
Assuntos
Antibacterianos/efeitos adversos , Ciprofloxacina/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Fármacos Anti-HIV/efeitos adversos , Síndrome de Fanconi/induzido quimicamente , Infecções por HIV/complicações , Rabdomiólise/induzido quimicamente , Tenofovir/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Sulfato de Atazanavir/uso terapêutico , Quimioterapia Combinada , Hidratação , Taxa de Filtração Glomerular/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Nevirapina/uso terapêutico , Rabdomiólise/terapia , Tenofovir/uso terapêuticoRESUMO
Extreme hypernatremia in intensive care unit are frequently associated with a poor prognosis and their treatment, when associated with acute renal failure, is not consensual. We report the case of a 39-year-old man admitted in our intensive care unit for coma who presented extreme hyperosmolar hypernatremia (sodium 180 mmol/L, osmolarity 507 mOsm/L) associated with acute renal failure (urea 139.3 mmol/L, creatinine 748 µmol/L) and many other metabolic abnormalities. He was treated with hypotonic fluid administration and continuous renal replacement therapy (veno-venous hemodiafiltration) using an industrial dialysate fluid. Natremia was controlled by modulating intravenous water and sodium intake according to biological data. After 10 days, continuous renal replacement therapy was stopped and neurological exam was normal. Continuous veno-venous hemodiafiltration may be useful for treatment of extreme hypernatremia by allowing gradual correction of fluid and electrolyte disorders.
Assuntos
Injúria Renal Aguda/terapia , Hemofiltração/métodos , Hipernatremia/terapia , Sódio/sangue , Injúria Renal Aguda/complicações , Adulto , Humanos , Masculino , Desequilíbrio Hidroeletrolítico/complicações , Desequilíbrio Hidroeletrolítico/terapiaRESUMO
A 79-year-old man with atherosclerosis presented blue toes and livedo reticularis. The patient had eroded aortic atheromatous plaques, and cholesterol embolization syndrome was suspected. An endovascular technique to exclude sources of cholesterol emboli was however performed. The patient immediately presented with severe muscle pain and total functional disability of lower limbs, new ischemic lesions of toes, anal and genital necrosis, and a livedo extended up to the abdomen. A massive rhabdomyolysis occurred associated with acute kidney injury and hyperkaliemia treated by continuous renal replacement therapy with regional citrate anticoagulation. Steroids have been introduced and renal function improved. Cholesterol crystals were also found on a skin biopsy, performed before endovascular procedure.