Quinine-induced renal failure as a result of rhabdomyolysis, haemolytic uraemic syndrome and disseminated intravascular coagulation.
This report describes a case of quinine-induced acute renal failure as a result of a combination of haemolytic uraemic syndrome and rhabdomyolysis with disseminated intravascular coagulation. The abrupt onset of symptoms occurred after ingestion of 300 mg of quinine along with atorvastatin. The patient recovered with supportive management, suggesting that plasma exchange may not be necessary in this situation. The possibility of a drug interaction contributing to rhabdomyolysis is raised. The proposed mechanism is through quinine inhibition of the cytochrome P450 isoenzyme 3A4, which may increase systemic levels of atorvastatin by reducing its first-pass metabolism.
Lim
A K H
AK
Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia. andykhlim@hotmail.com
Ho
L
L
Levidiotis
V
V
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000209:etiology*; D000924:Anticholesteremic Agents / Q000009:adverse effects*; D000069059:Atorvastatin; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced; D004357:Drug Synergism; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced; D006538:Heptanoic Acids / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D011758:Pyrroles / Q000009:adverse effects*; D011803:Quinine / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced; D020922:Sleep-Wake Transition Disorders / Q000188:drug therapy
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D009125:Muscle Relaxants, Central; D011758:Pyrroles; D000069059:Atorvastatin; D011803:Quinine