Acute kidney damage due to statin taken: case description and literature review

Statin-induced myopathy is an underappreciated clinical problem. According to randomized clinical trials, the drugs are highly safe, however, a number of authors note that intolerance to statins can be observed in every 7–10 patients, and statin-associated muscle syndromes (SAMS) are even more common (up to 29%).

A case of acute kidney injury while taking statins is presented, demonstrating the difficulties of differential diagnosis of kidney damage in comorbid elderly patients. An 83-year-old man was delivered in serious condition from another hospital with a diagnosis of end-stage CKD. Upon admission, an increase in myoglobin to 262144 was noted, CPK total. >80 ULN (upper limit of normal), LDH >8 ULN, AlAt >30 ULN, AST >19 ULN, creatinine – 589 U/l, urea – 32.7 mmol/l, as a result of which the diagnosis was revised in favor of SAMS: rhabdomyolysis with the development of myoglobinuric nephrosis (a variant of tubulointerstitial nephritis), statin-induced liver damage (drug-induced hepatitis). Four risk factors for the development of SAMS were immediately identified: old age, hypothyroidism, impaired renal and liver function, high-dose statin therapy (atorvastatin 80 mg, rosuvastatin 40 mg per day). In the hospital, the patient received complex therapy (including: acute hemodialysis, plasmapheresis, correction of anemia, forced diuresis, correction of hypothyroidism), after which he was discharged in satisfactory condition.

Thus, when prescribing statins, special attention should be paid to comorbid elderly patients who already have kidney disease, thyroid disease and other risk factors for the development of adverse reactions, and, if possible, eliminate them. Then select the dose individually and promptly assess the safety of the therapy.