Severe recurrent rhabdomyolysis-induced acute kidney injury in a HIV-infected patient on antiretroviral therapy

Spiegel, Louis; Schrier, Peter Bryan; Shah, Hitesh H.

doi:10.3109/0886022x.2013.817316

Cited by 10 publications

(12 citation statements)

References 23 publications

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“…21 Delaying administration of HAART in HIV patients with AKI prevents further renal injury from the medications' nephrotoxic nature. 22 Prior to discontinuation upon hospitalization, our patient's HAART regimen consisted of lopinavir and ritonavir. The patient endorsed compliance with his HAART regimen prior to hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] Although the lopinavir/ritonavir combination drug has been investigated as a potential treatment regimen for COVID-19, there has been conflicting evidence in terms of efficacy. [21][22][23][24][25][26] Some studies have reported a reduction of symptoms and SARS-CoV-2 viral load when initiated early in the treatment course. 2 Despite the recommendation by early studies that lopinavir/ritonavir should be used in vulnerable populations with COVID-19 pneumonia, more evidence is needed to enforce this practice.…”

Section: Discussionmentioning

confidence: 99%

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It’s complicated: A case report on a COVID-19-positive HIV patient presenting with rhabdomyolysis and acute kidney injury

Foster

Khan

Siddiqui

et al. 2020

SAGE Open Medical Case Reports

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The SARS-Cov-2/COVID-19 pandemic in early 2020 has had a devastating impact on health systems around the world. While viral pneumonia remains the most common complication, reports are surfacing of cases with neurological, cardiac, and renal involvement. Even less is known about the implications in special high-risk populations. In this report, we discuss a unique case of an HIV-positive patient in New York City who presented with a 2-week history of worsening fatigue, cough, dyspnea, and myalgias and was found to have COVID-19 pneumonia and acute kidney injury. He was managed for severe uremic metabolic acidosis and electrolyte abnormalities with emergent hemodialysis and supportive therapy with subsequent improvement. Direct involvement of SARS-CoV-2 and pneumonia-induced rhabdomyolysis were identified as the precipitating factors of his acute kidney injury. The pathophysiologic mechanisms of acute kidney injury, SARS-CoV-2 renal tropism, and the impact of highly active antiretroviral therapy on COVID-19 pneumonia are discussed. We highlight the importance of clinician awareness of this potentially fatal complication of COVID-19 pneumonia, particularly in the HIV-positive population as early recognition and management can have favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

It’s complicated: A case report on a COVID-19-positive HIV patient presenting with rhabdomyolysis and acute kidney injury

Foster

Khan

Siddiqui

et al. 2020

SAGE Open Medical Case Reports

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“…The patient described here presented with acute kidney injury AKIN stage III induced by severe rhabdomyolysis that was diagnosed 10 days after the introduction of Genvoya®. The main causes of rhabdomyolysis comprise crush injury, burns, infections, medications, drug use, and extreme exercise [2]. Acute kidney failure is a frequent complication [3, 4].…”

Section: Discussionmentioning

confidence: 99%

Severe rhabdomyolysis-induced acute kidney injury following concomitant use of Genvoya® (EVG/COBI/FTC/TAF) and simvastatin; a case report

et al. 2019

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Background Genvoya® (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide) is a recent single regimen for the treatment of Human Immunodeficiency Virus (HIV). However, because of its complexity, it is difficult to predict drug interactions, especially when associated with HMG-CoA reductase inhibitors and/or in the setting of other comorbidities. We discuss the mechanisms of these potential drug interactions as the cause of rhabdomyolysis and acute kidney injury in the context of prior and current medication therapy with possible underlying liver and kidney dysfunction. Case presentation We describe the case of a 54-year-old man diagnosed with HIV who developed severe rhabdomyolysis-induced anuric acute kidney injury (AKI) requiring renal replacement therapy following introduction of Genvoya® concomitantly with simvastatin, in the context of recently diagnosed hepatitis C and hepatitis A. Haemodialysis was continued over 5 weeks followed by progressive clinical and biological improvements. Five months later, a new antiretroviral regimen was started and has been well tolerated. Conclusion Simvastatin, as well as lovastatin, because of their CYP3A4 metabolism, and to a lesser extent atorvastatin, which is only partially metabolized by CYP3A4, are the HMG-CoA reductase inhibitors with the greatest risk of drug interactions and should not be used in patients under HIV-therapy. Patients receiving HMG-CoA reductase inhibitors should be monitored regularly for the occurrence of muscular adverse effects and drug interactions should be considered with each new prescription or change in clinical status. There are many online tools that enable clinicians to rapidly check for drug interactions. We recommend the one from the University of Liverpool for patients under HIV-therapy ( https://www.hiv-druginteractions.org/checker ), while for patients under hepatitis C-therapy, we advise to consult http://www.hep-druginteractions.org/ . This case illustrates the importance of multidisciplinary collaboration in the treatment of HIV-positive patients because of their complexity, associated comorbidities and the potential of multiple drug-drug interactions potentially exacerbated by underlying liver and/or kidney dysfunction.

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“…Ritonavir can cause nephrotoxicity itself [7] as well as increase levels of other medications used concomitantly. Spiegel et al [32] described a case of acute renal failure in a patient receiving abacavir. Serum creatinine levels reflect renal function, and the positive correlation between β 2 M and serum creatinine shown in our study confirms its usefulness.…”

Section: Discussionmentioning

confidence: 99%

Concentration of selected low molecular-weight proteins in urine – a retrospective analysis of chronic kidney disease among HIV patients receiving antiretroviral therapy

Marchewka¹,

Szymańska²,

Domagała³

et al. 2019

HIV & AIDS Review

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Introduction: Human immunodeficiency virus (HIV) infection remains an important health problem despite the fact that combined antiretroviral therapy (cART) prolongs life and protects against acquired immunodeficiency syndrome (AIDS). Chronic kidney disease is an important cause of mortality among HIV patients, co-monitoring of renal function and modifying factors such as cART require constant analysis. The aim of this study was a retrospective analysis of renal function among HIVinfected and cART-treated patients by measuring urine concentrations of chosen low molecular weight proteins (LMWP) as biomarkers of kidney dysfunction: retinol-binding protein (RBP), β 2-microglobulin (β 2 M), and neutrophil gelatinase-associated lipocalin (NGAL). The results were compared with those obtained seven years earlier (in 2011) in the same patients. Material and methods: Urine samples from 34 patients of Wroclaw outpatient HIV Clinic and from 30 HIV-negative individuals with no renal or any other disease were examined. Concentrations of LMWP were measured by immunoenzymatic ELISA tests. Results: Compared to 2011, reduction in the concentration of excreted LMWP was observed. No deleterious renal effect of tenofovir could be shown; however, most patients were receiving the new prodrug (TAF) of reduced nephrotoxicity. Positive correlation between serum creatinine and urine β 2 M was shown and negative correlation between eGFR and urine RBP. Coexistence of HCV infection and the number of T CD4(+) cells also correlated with the concentration of the biomarkers. Conclusions: This retrospective analysis shows a need for long-term renal function monitoring as well as other factors that may influence renal function among HIV patients. RBP, NGAL, and β 2 M have been confirmed to be useful biomarkers for early detection of renal dysfunction.

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Severe recurrent rhabdomyolysis-induced acute kidney injury in a HIV-infected patient on antiretroviral therapy

Cited by 10 publications

References 23 publications

It’s complicated: A case report on a COVID-19-positive HIV patient presenting with rhabdomyolysis and acute kidney injury

It’s complicated: A case report on a COVID-19-positive HIV patient presenting with rhabdomyolysis and acute kidney injury

Severe rhabdomyolysis-induced acute kidney injury following concomitant use of Genvoya® (EVG/COBI/FTC/TAF) and simvastatin; a case report

Concentration of selected low molecular-weight proteins in urine – a retrospective analysis of chronic kidney disease among HIV patients receiving antiretroviral therapy

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