title: Renal Tubular Toxicity Associated With Rosuvastatin Therapy.
abstract: Preapproval clinical trials examining the safety and efficacy of rosuvastatin demonstrated an increased incidence of proteinuria, hematuria, rhabdomyolysis, and other acute kidney injury of unknown cause at high doses. The latter cases manifested with urine sediment findings and in some cases, renal histology, indicating renal tubular injury in the absence of rhabdomyolysis. Despite these provocative findings, there have been very few reports in the literature regarding non-rhabdomyolysis-mediated acute kidney injury associated with high-dose rosuvastatin since its widespread introduction more than a decade ago, suggesting that it is either a rare entity or systematically underdiagnosed and under-reported. We present a case of renal tubular toxicity attributable to the initiation of rosuvastatin treatment at a dose of 40mg in a patient with no prior evidence of kidney disease. Tubular toxicity should be considered in cases of unexplained kidney injury in the setting of exposure to a potent statin such as rosuvastatin, particularly at high dose. The limited evidence suggests a good kidney prognosis following withdrawal of the agent in these cases.
authors.affiliation: Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada. Electronic address: francis.ward@uhn.ca.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Ward
authors.affiliation: Department of Pathology, University Health Network, Toronto, Canada.
authors.forename: Rohan
authors.initials: R
authors.lastname: John
authors.affiliation: Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
authors.affiliation: Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada.
authors.forename: Rory F
authors.initials: RF
authors.lastname: McQuillan
mesh_terms: D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced*; D008875:Middle Aged; D000068718:Rosuvastatin Calcium / Q000009:adverse effects*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium
keywords: Acute kidney injury (AKI); acute tubular necrosis; rosuvastatin; statin; tubular toxicity