title: From a fish tank injury to hospital haemodialysis: the serious consequences of drug interactions.
abstract: We present the case of a 68-year-old man admitted to hospital with severe acute kidney injury secondary to statin-induced rhabdomyolysis. Five weeks previously, the patient started a course of clarithromycin for infection of a finger wound with Mycobacterium marinum. His current medications included simvastatin, which he continued along with clarithromycin. The severity of the acute kidney injury necessitated initial continuous venovenous haemofiltration followed by 12 haemodialysis sessions before a spontaneous improvement in renal function occurred. Statins are widely prescribed and we report this case to encourage increased vigilance in avoiding drug interactions known to increase the risk of statin-induced myopathy, including macrolide antibiotics, calcium channel antagonists and amiodarone. The authors would also like to highlight recent guidance on atorvastatin as the statin of choice in patients with chronic kidney disease, and of the need for dose adjustment in those with an estimated glomerular filtration rate less than 30 mLs/min/1.73 m².
authors.affiliation: Renal Department, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, UK.
authors.forename: Fay Joanne
authors.initials: FJ
authors.lastname: Hill
authors.affiliation: Renal Department, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, UK.
authors.forename: Sarah Jane
authors.initials: SJ
authors.lastname: McCloskey
authors.affiliation: Institute of Cellular Medicine, Newcastle Upon Tyne, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Sheerin
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017291:Clarithromycin / Q000009:adverse effects; D004347:Drug Interactions; D004977:Ethambutol / Q000009:adverse effects; D005383:Finger Injuries / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000188:drug therapy; D006435:Renal Dialysis; D012206:Rhabdomyolysis / Q000139:chemically induced*; D012293:Rifampin / Q000009:adverse effects; D019821:Simvastatin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D004977:Ethambutol; D019821:Simvastatin; D017291:Clarithromycin; D012293:Rifampin