REVERSIBLE CHRONIC KIDNEY DISEASE IN A PATIENT ON ROSUVASTATIN WITH MYOGLOBINURIA DETECTED BY INCREASED NON-ALBUMIN PROTEINURIA
PATRICK MANLEY1, ANDREW BOFINGER1 1Greenslopes Private Hospital, Greenslopes, Queensland, Australia
Abstract
Background
Current CKD staging classifications and diabetes management guidelines focus on eGFR and albuminuria. However, monitoring of albuminuria alone may not detect the development of all relevant abnormalities. Rosuvastatin is a potent statin which is widely used to achieve tight LDL targets. In phase 3 studies, rosuvastatin was found to be associated with an increased risk of developing haematuria +/- proteinuria.
Case Report
A 66-year-old female was referred for declining renal function on a background of type 2 diabetes, hypertension, atrial fibrillation, hepatosteatosis and dyslipidaemia. Medications included rosuvastatin, amiodarone, amlodipine, metformin, esomeprazole, rivaroxaban, telmisartan-hydrochlorothiazide and budesonide–formoterol. Her serum creatinine (SeCr) had been around 90 umol/l for 6 months, from 51 umol/l one year prior. At referral, in November 2019, the urine albumin:creatinine ratio (ACR) was 13 mg/mmol and the protein:creatinine ratio (PCR) 64 mg/mmol, with a normal urine ACR 3 years earlier. Bence Jones Proteins (BJP) were negative. An autoimmune screen, complement C3 and C4, creatine kinase, urine microscopy and renal imaging were unremarkable. The SeCr increased over 16 months to 105 umol/L and stabilised for another 16 months. In September 2022, the SeCr rose acutely to 150 umol/l. The urine ACR was 20 mg/mmol and the PCR 198 mg/mmol. BJP were again negative. The urine was positive for myoglobin. Rosuvastatin was ceased. Three weeks later, the SeCr was 88 umol/l with complete and sustained resolution of the albuminuria and proteinuria.
Conclusion
This case demonstrates the utility of measuring both urine albumin and protein with unexpected changes in renal function, the possibility of myoglobinuria in non-albumin proteinuria, even when CK has been normal, and the need for awareness of rosuvastatin as a possible renal toxin.
Biography
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