Insuficiência renal aguda e rabdomiólise induzida pelo uso de estatina: relato de caso

JUSTIFICATIVA E OBJETIVOS: A habilidade das estatinas em reduzir a morbimortalidade dos pacientes com dislipidemia esta bem estabelecida. Os efeitos adversos sao geralmente leves e temporarios. As complicacoes mais importantes e indesejaveis sao a elevacao das enzimas hepaticas, miopatia e rabdomiolise, que se caracteriza por necrose muscular, mioglobinuria e insuficiencia renal aguda. No geral, as estatinas estao relacionadas a um pequeno risco de miopatia que pode progredir para rabdomiolise fatal ou nao fatal. A incidencia esta relacionada com a dose e o uso concomitante de agentes que compartilham a mesma via metabolica das estatinas. A insuficiencia renal aguda e a mais temida complicacao da rabdomiolise e a principal causa de obito. O reconhecimento e tratamento precoce podem prevenir a progressao da rabdomiolise. RELATO DO CASO: Paciente do sexo masculino, 57 anos, sem historia previa de doenca renal evolui com insuficiencia renal aguda e rabdomiolise, induzida por alta dose de estatina (sinvastatina 80 mg/dia). CONCLUSAO: Os clinicos devem estar alerta para as interacoes medicamentosas das estatinas a fim de minimizar o risco de miopatia. Ao prescrever estatinas o medico deve considerar as comorbidades e fatores de risco, incluindo uso de multiplas medicacoes, e iniciar estatina com a menor dose possivel em idosos. Se houver suspeita deste efeito adverso, o farmaco deve ser suspenso. BACKGROUND AND OBJECTIVES: The ability of statins to reduce the risk of cardiovascular morbimortality in patients with dyslipidemia is well established. The adverse effects associated with statins are usually mild and transient. The most noteworthy adverse effects associated with statins are elevations in liver transaminasis, myopathy and rhabdomyolysis, which is characterized by massive muscle necrosis, myoglobinuria and acute renal failure. In general, statins are associated with a very small risk of myopathy (with may progress to fatal or nonfatal rhabdomyolysis). The incidence is dose related and is increased when statins are used in combination with agents that share common metabolic pathways. Acute renal failure is the most serious complication of rhabdomyolysis and the main cause of death. Early recognition and treatment may prevent the progression of rhabdomyolysis. CASE REPORT: A 57 year-old-man, with no history of renal dysfunction presented with acute renal failure and rhabdomyolysis induced by high-dose statin (simvastatin 80 mg/day). CONCLUSION: Clinicians should be alert for drug-drug interactions to minimize the risk of myopathy. The prescribing physician should consider the co-morbid risk factors, including polypharmacy, and initiate statin at a lower dose in the elderly. If rhabdomyolysis is suspected the statin therapy should be withdrawn.