Unal Aydin, Torun Edip, Sipahioglu Murat Hayri, Tokgoz Bulent, Kaya Mehmet Gungor, Oymak Oktay, Utas Cengiz
Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey.
Intern Med. 2008;47(11):1017-9. doi: 10.2169/internalmedicine.47.0939. Epub 2008 Jun 2.
Fibric acid derivatives and statins have been increasingly recognized as causes of rhabdomyolysis and acute renal failure. We report severe rhabdomyolysis and acute renal failure associated to combination treatment with statin and fenofibrate in two patients with underlying coronary artery disease. Both patients developed rhabdomyolysis-induced acute renal failure after their hyperlipidemia treatment was changed from statin to statin plus fenofibrate. Both patients experienced intense muscle symptoms, hemoglobinuria, oliguria, and elevation of blood urea nitrogen and serum creatinine. Their serum creatine kinase levels were markedly elevated (case 1; 97,392 IU/l and case 2; 96,639 IU/l). Rhabdomyolysis induced acute renal failure was diagnosed in both patients. Both patients were managed with cessation of the statin-fibrate combination, adequate fluid resuscitation and forced alkaline-mannitol diuresis. Although both patients required hemodialysis, their renal function recovered. Fenofibrate initiation is associated with an increased risk for rhabdomyolysis in patients receiving statin therapy. To prevent future events, it is crucial that clinicians recognize the interaction risk associated with concurrent use of statin and fenofibrate. We recommend careful monitoring when fenofibrate is given to patients receiving statin therapy.
纤维酸衍生物和他汀类药物越来越被认为是横纹肌溶解症和急性肾衰竭的病因。我们报告了两例患有冠状动脉疾病的患者，在接受他汀类药物和非诺贝特联合治疗后出现严重横纹肌溶解症和急性肾衰竭。两名患者在高脂血症治疗从他汀类药物改为他汀类药物加非诺贝特后均发生了横纹肌溶解症诱发的急性肾衰竭。两名患者均出现强烈的肌肉症状、血红蛋白尿、少尿以及血尿素氮和血清肌酐升高。他们的血清肌酸激酶水平显著升高（病例1为97392 IU/L，病例2为96639 IU/L）。两名患者均被诊断为横纹肌溶解症诱发的急性肾衰竭。两名患者均通过停用他汀类药物与贝特类药物的联合治疗、充分的液体复苏以及强制碱性甘露醇利尿进行处理。尽管两名患者都需要进行血液透析，但他们的肾功能恢复了。在接受他汀类药物治疗的患者中，开始使用非诺贝特会增加横纹肌溶解症的风险。为预防未来发生此类事件，临床医生认识到他汀类药物和非诺贝特同时使用的相互作用风险至关重要。我们建议在给接受他汀类药物治疗的患者使用非诺贝特时进行仔细监测。
