Fenofibrate-induced acute renal failure due to massive rhabdomyolysis after coadministration of statin in two patients.
Fenofibrate-induced acute renal failure due to massive rhabdomyolysis after coadministration of statin in two patients.
复制标题
两名患者同时服用他汀类药物后，由于大量横纹肌溶解，非诺贝特诱发急性肾功能衰竭。
DOI：
10.2169/internalmedicine.47.0939
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发表时间：
2008
影响因子：
1.2
通讯作者：
C. Utaş
中科院分区：
文献类型：
--
作者：
A. Unal;E. Torun;M. Sipahioğlu;B. Tokgoz;M. Kaya;O. Oymak;C. Utaş
纤维酸衍生物和他汀类药物越来越多地被认为是横纹肌溶解和急性肾功能衰竭的原因。我们报告了两名潜在冠状动脉疾病患者中与他汀类药物和非诺贝特联合治疗相关的严重横纹肌溶解和急性肾功能衰竭。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，均出现横纹肌溶解所致的急性肾功能衰竭。两名患者都有强烈的肌肉症状、血红蛋白尿、少尿以及血尿素氮和血肌酐升高。血清肌酸激酶水平明显升高(例1：97,392IU/L和例2：96,639IU/L)。两名患者均诊断为横纹肌溶解症所致的急性肾功能衰竭。两名患者均经停用他汀类药物、充分的液体复苏和强迫性碱性甘露醇利尿治疗。虽然两名患者都需要血液透析，但他们的肾功能都恢复了。在接受他汀类药物治疗的患者中，非诺贝特治疗与横纹肌溶解风险增加有关。为了预防未来的事件，至关重要的是临床医生认识到与同时使用他汀类药物和非诺贝特相关的相互作用风险。当接受他汀类药物治疗的患者服用非诺贝特时，我们建议仔细监测。
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.