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Gorrie MJ, MacGregor MS, Rodger RSC

Acute on chronic renal failure induced by simvastatin

Nephrol Dial Transplant (Nov) 11:2328-2329 1996

Statins, drugs used to lower cholesterol synthesis by virtue of their ability to inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase, have seen their use expand in the expectation of lowering the incidence of myocardial infarctions and stroke in patients with elevated serum cholesterol levels, and perhaps even in patients with only mild serum cholesterol elevation. Their use in patients with renal impairment has been tempered by knowledge that they can increase the risk of rhabdomyolysis, particularly when given with concomitant cyclosporine therapy, fibric acid derivatives, nicotinic acid, or erythromycin.

This report describes a patient with a creatinine clearance of 18 ml/min to whom simvastatin 20 mg/daily was prescribed, and in whom the serum creatinine doubled, with concomitant mild elevation of the creatinine kinase levels. There were no overt signs of rhabdomyolysis. Simvastatin was stopped, and the serum creatinine level returned almost to baseline, only to increase markedly after simvastatin was reintroduced. Simvastatin was stopped and renal function recovered.

Comment: The report here is suggestive and causality not completely established. However, the report should be kept in mind and simvastatin used with some caution in patients with impaired renal function until more information is available on its safety profile in patients with renal impairment. (John T. Daugirdas, M.D., University of Illinois at Chicago)