[Rhabdomyolysis and acute renal failure secondary to statins].
Statins are competitive inhibitors of hydroxy-methyl-glutaryl coenzyme A (HMG-CoA) reductase and are the most commonly used drugs to treat hyperlipidaemia. Muscle toxicity is an adverse effect reported with a low incidence and rarely associated with acute renal failure due to rhabdomyolysis. We describe two patients with chronic renal failure treated with pravastatin and simvastatin who suffered rhabdomyolysis and acute renal failure. One patient started pravastatin several days after cessation of bezafibrate and developed acute renal failure without needing dialysis. The other was treated with simvastatin three years ago and suffered rhabdomyolysis when renal function was impaired after indomethacin was prescribed for backache. He needed hemodialysis because of acute cardiac failure and died from a respiratory infection while on mechanical ventilation. Myopathy was reversible in both patients. We recommend starting statins with the lower doses in chronic renal failure and monitoring muscle enzymes when renal function changes or when new drugs with potential interactions are prescribed.
Borrego
F J
FJ
Servicio de Nefrología, Hospital General de Especialidades Ciudad de Jaén, Jaén. fborregou@senefro.org
Liébana
A
A
Borrego
J
J
Pérez del Barrio
P
P
Gil
J M
JM
García Cortés
M J
MJ
Sánchez Perales
C
C
Serrano
P
P
Pérez Bañasco
V
V
D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D001416:Back Pain / Q000188:drug therapy; D001629:Bezafibrate / Q000494:pharmacology / Q000627:therapeutic use; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D004231:Diuresis; D004357:Drug Synergism; D017809:Fatal Outcome; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D008658:Inactivation, Metabolic; D007213:Indomethacin / Q000009:adverse effects / Q000493:pharmacokinetics; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000378:metabolism; D009102:Multiple Organ Failure / Q000209:etiology; D017035:Pravastatin / Q000009:adverse effects* / Q000493:pharmacokinetics; D006435:Renal Dialysis; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000150:complications; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D019821:Simvastatin / Q000009:adverse effects*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003577:Cytochrome P-450 Enzyme System; D019821:Simvastatin; D006899:Mixed Function Oxygenases; C104464:CYP3A protein, human; D051544:Cytochrome P-450 CYP3A; D017035:Pravastatin; D007213:Indomethacin; D001629:Bezafibrate