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Böbrek Nakilli Hastada Simvastatin Kullanımına Bağlı Gelişen Akut Rabdomyoliz

Simvastatin Induced Acute Rhabdomyolysis in a Renal Transplant Patient

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Abstract (2. Language): 
The risk of development of rhabdomyolysis and myoglobinuric acute graft failure is higher than the general population in renal transplant recipients with concomitant use of cyclosporine A and statin. A 64-year-old female patient, who underwent renal transplantation from a living donor in Germany 14 years ago, had diabetes mellitus, hyperlipidemia and hypertension in her past medical history. During her follow up in this country, simvastatin 80 mg/day was added to her therapy due to hyperlipidemia. Her biochemical analysis revealed serum creatine phosphokinase (CPK) of 27336 u/L, cretine kinase –MB (CK-MB): >300 ng/mL, myoglobin >4000 ng/mL, urea: 284 mg/dL, creatinine: 5.1 mg/dL and cyclosporine level: 145.6. Although her serum CPK, CK-MB, myoglobin levels returned to normal levels during her 25-day follow-up, her renal function test levels did not improve and she was accepted to have chronic renal failure. An AV fistula was opened and she was entered into a routine hemodialysis program. In conclusion, simvastatin may cause serious adverse effects in renal transplant patients. One should be very careful and the patient should be followed very closely when it is used.
Abstract (Original Language): 
Uzun dönemde renal transplant alıcılarında mortalite ve morbiditeyi etkileyen en sık sebep kardiyovasküler hastalıklardır. Canlı donörden Almanya’da 14 yıl önce böbrek nakli yapılan 63 yaşındaki kadın hastanın diabetes mellitus, hiperlipidemi ve hipertansiyon tanıları vardı. Hastaya bu ülkedeki takiplerinde hiperlipidemisi nedeniyle de simvastatin 80 mg eklenmişti. Hastanın biyokimyasal parametrelerinde serum CPK: 27336 u/L, CK-MB: >300 ng/ mL, myoglobin >4000 ng/mL, üre: 284 mg/dL, kreatinin: 5,1 mg/dL, siklosporin düzeyi:145,6 saptandı. Yaklaşık 25 günlük takibinde serum CPK, CK-MB, myoglobin değerleri normal seviyelere gelmesine rağmen böbrek fonksiyon testleri yüksek seyretmesi üzerine kronik rejeksiyon kabul edildi. AV fistül açılarak kronik hemodiyaliz programına alındı. Sonuç olarak; böbrek nakilli hastalarda simvastatin ciddi yan etkilere neden olabilir; kullanılacağı zaman doz ayarlamasında çok dikkatli olunmalı ve rabdomyoliz açısından yakından izlenmelidir.
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REFERENCES

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