Login Register Cart 0
Generic placeholder image

Endocrine, Metabolic & Immune Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

Cardiorenal Syndrome Triggered by Slowly Progressive Drugs Toxicity-Induced Renal Failure along with Minimal Mitral Disease: A Case Report

Author(s): Carlo Caiati*, Adriana Argentiero, Stefano Favale and Mario Erminio Lepera

Volume 22, Issue 9, 2022

Published on: 15 June, 2022

Page: [970 - 977] Pages: 8

DOI: 10.2174/1381612828666220412093734

Price: $65

conference banner
Abstract

Background: We report the case of a 93-year-old patient with normal left ventricular function and severe mitral annulus calcification, with mild mitral steno-insufficiency.

Case Presentation: She had developed creeping drugs-induced renal toxicity that is generally totally overlooked, due mainly to statins, a proton pump inhibitor, and aspirin. The Na and fluid retention, along with hypertension that ensued, although not severe, caused acute heart failure (sub-pulmonary edema) by worsening the mitral insufficiency. This occurred due to a less efficient calcific mitral annulus contraction during systole and an increasing mitral transvalvular gradient, as the transvalvular mitral gradient has an exponential relation to flow. After the suspension of the nephrotoxic drugs and starting intravenous furosemide, she rapidly improved. At 6 months follow-up, she is stable, in an NYHA 1-2 functional class, despite the only partial recovery of the renal function.

Conclusion: Progressive renal failure can functionally worsen even minimal mitral valvulopathy. Drug-induced nephrotoxicity can always be suspected in case of renal failure of unknown etiology. The suspension of the culprit drugs can improve renal function and dramatically improve the clinical symptoms even in a nonagenarian.

Keywords: Renal insufficiency, kidney toxicity, heart failure, mitral annulus calcification, sub-pulmonary edema, nephrotoxicity.

« Previous
Graphical Abstract

[1]
Roger, V.L. Epidemiology of heart failure. Circ. Res., 2013, 113(6), 646-659.
[http://dx.doi.org/10.1161/CIRCRESAHA.113.300268] [PMID: 23989710]
[2]
Verdoodt, A.; Honore, P.M.; Jacobs, R.; De Waele, E.; Van Gorp, V.; De Regt, J.; Spapen, H.D. Do statins induce or protect from acute kidney injury and chronic kidney disease: An update review in 2018. J. Transl. Int. Med., 2018, 6(1), 21-25.
[http://dx.doi.org/10.2478/jtim-2018-0005] [PMID: 29607300]
[3]
Perazella, M.A. Renal vulnerability to drug toxicity. Clin. J. Am. Soc. Nephrol., 2009, 4(7), 1275-1283.
[http://dx.doi.org/10.2215/CJN.02050309] [PMID: 19520747]
[4]
Perazella, M.A. Toxic nephropathies: Core curriculum 2010. Am. J. Kidney Dis., 2010, 55(2), 399-409.
[http://dx.doi.org/10.1053/j.ajkd.2009.10.046] [PMID: 20042257]
[5]
Pazhayattil, G.S.; Shirali, A.C. Drug-induced impairment of renal function. Int. J. Nephrol. Renovasc. Dis., 2014, 7, 457-468.
[PMID: 25540591]
[6]
Rangaswami, J.; Bhalla, V.; Blair, J.E.A.; Chang, T.I.; Costa, S.; Lentine, K.L.; Lerma, E.V.; Mezue, K.; Molitch, M.; Mullens, W.; Ronco, C.; Tang, W.H.W.; McCullough, P.A. Cardiorenal syndrome: Classification, pathophysiology, diagnosis, and treatment strategies: A scientific statement from the american heart association. Circulation, 2019, 139(16), e840-e878.
[http://dx.doi.org/10.1161/CIR.0000000000000664] [PMID: 30852913]
[7]
Rennke, H.G.; Bradley, M.D. Renal Pathophysiology. The essentials, 4th ed; Wolters Kluwer- Lippincot Williams & Wilkins: Baltimore, MD, 2014.
[8]
Massera, D.; Kizer, J.R.; Dweck, M.R. Mechanisms of mitral annular calcification. Trends Cardiovasc. Med., 2020, 30(5), 289-295.
[http://dx.doi.org/10.1016/j.tcm.2019.07.011] [PMID: 31402089]
[9]
Kannan, M.; Vijayanand, G. Mitral stenosis and pregnancy: Current concepts in anaesthetic practice. Indian J. Anaesth., 2010, 54(5), 439-444.
[http://dx.doi.org/10.4103/0019-5049.71043] [PMID: 21189882]
[10]
Lødrup, A.B.; Reimer, C.; Bytzer, P. Systematic review: Symptoms of rebound acid hypersecretion following proton pump inhibitor treatment. Scand. J. Gastroenterol., 2013, 48(5), 515-522.
[http://dx.doi.org/10.3109/00365521.2012.746395] [PMID: 23311977]
[11]
Bordia, T.; Mohammed, N.; Thomson, M.; Ali, M. An evaluation of garlic and onion as antithrombotic agents. Prostaglandins Leukot. Essent. Fatty Acids, 1996, 54(3), 183-186.
[http://dx.doi.org/10.1016/S0952-3278(96)90014-9] [PMID: 8860105]
[12]
Rahman, M.; Smith, M.C. Chronic renal insufficiency: A diagnostic and therapeutic approach. Arch. Intern. Med., 1998, 158(16), 1743-1752.
[http://dx.doi.org/10.1001/archinte.158.16.1743] [PMID: 9738603]
[13]
Naughton, C.A. Drug-induced nephrotoxicity. Am. Fam. Physician, 2008, 78(6), 743-750.
[PMID: 18819242]
[14]
Caiati, C.; Pollice, P.; Favale, S.; Lepera, M.E. The herbicide glyphosate and its apparently controversial effect on human health: An updated clinical perspective. Endocr. Metab. Immune Disord. Drug Targets, 2020, 20(4), 489-505.
[http://dx.doi.org/10.2174/1871530319666191015191614] [PMID: 31613732]
[15]
Snyder, J.W. Mechanisms of toxic cell injury. Clin. Lab. Med., 1990, 10(2), 311-321.
[http://dx.doi.org/10.1016/S0272-2712(18)30571-7] [PMID: 2197051]
[16]
Zanger, U.M.; Schwab, M. Cytochrome P450 enzymes in drug metabolism: Regulation of gene expression, enzyme activities, and impact of genetic variation. Pharmacol. Ther., 2013, 138(1), 103-141.
[http://dx.doi.org/10.1016/j.pharmthera.2012.12.007] [PMID: 23333322]
[17]
Brenner, B.M.; Lazarus, J.M. Chronic renal failure. In:Harrison’s principles of internal medicine; 12th ed; Wilson, J.D.; Braunwald, E.; Isselbacker, K.J.; Petersdorf, R.G.; Martin, J.B.; Fauci, A.S., Eds.; McGraw-Hill, Inc: New York, 1991, pp. 1151-1157.
[18]
Wolfe, S.M. Dangers of rosuvastatin identified before and after FDA approval. Lancet, 2004, 363(9427), 2189-2190.
[http://dx.doi.org/10.1016/S0140-6736(04)16513-6] [PMID: 15220045]
[19]
Acharya, T.; Huang, J.; Tringali, S.; Frei, C.R.; Mortensen, E.M.; Mansi, I.A. Statin use and the risk of kidney disease with long-term follow-up (8.4-Year Study). Am. J. Cardiol., 2016, 117(4), 647-655.
[http://dx.doi.org/10.1016/j.amjcard.2015.11.031] [PMID: 26742473]
[20]
Sarma, A.; Cannon, C.P.; de Lemos, J.; Rouleau, J.L.; Lewis, E.F.; Guo, J.; Mega, J.L.; Sabatine, M.S.; O’Donoghue, M.L. The incidence of kidney injury for patients treated with a high-potency versus moderate-potency statin regimen after an acute coronary syndrome. J. Am. Heart Assoc., 2014, 3(3), e000784.
[http://dx.doi.org/10.1161/JAHA.114.000784] [PMID: 24786143]
[21]
Baigent, C.; Landray, M.J.; Reith, C.; Emberson, J.; Wheeler, D.C.; Tomson, C.; Wanner, C.; Krane, V.; Cass, A.; Craig, J.; Neal, B.; Jiang, L.; Hooi, L.S.; Levin, A.; Agodoa, L.; Gaziano, M.; Kasiske, B.; Walker, R.; Massy, Z.A.; Feldt-Rasmussen, B.; Krairittichai, U.; Ophascharoensuk, V.; Fellström, B.; Holdaas, H.; Tesar, V.; Wiecek, A.; Grobbee, D.; de Zeeuw, D.; Grönhagen-Riska, C.; Dasgupta, T.; Lewis, D.; Herrington, W.; Mafham, M.; Majoni, W.; Wallendszus, K.; Grimm, R.; Pedersen, T.; Tobert, J.; Armitage, J.; Baxter, A.; Bray, C.; Chen, Y.; Chen, Z.; Hill, M.; Knott, C.; Parish, S.; Simpson, D.; Sleight, P.; Young, A.; Collins, R. SHARP Investigators. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): A randomised placebo-controlled trial. Lancet, 2011, 377(9784), 2181-2192.
[http://dx.doi.org/10.1016/S0140-6736(11)60739-3] [PMID: 21663949]
[22]
Tonelli, M.; Lloyd, A.M.; Bello, A.K.; James, M.T.; Klarenbach, S.W.; McAlister, F.A.; Manns, B.J.; Tsuyuki, R.T.; Hemmelgarn, B.R. Alberta Kidney Disease Network. Statin use and the risk of acute kidney injury in older adults. BMC Nephrol., 2019, 20(1), 103.
[http://dx.doi.org/10.1186/s12882-019-1280-7] [PMID: 30909872]
[23]
van Zyl-Smit, R.; Firth, J.C.; Duffield, M.; Marais, A.D. Renal tubular toxicity of HMG-CoA reductase inhibitors. Nephrol. Dial. Transplant., 2004, 19(12), 3176-3179.
[http://dx.doi.org/10.1093/ndt/gfh474] [PMID: 15575008]
[24]
Annigeri, R.A.; Mani, R.M. Acute interstitial nephritis due to statin and its class effect. Indian J. Nephrol., 2015, 25(1), 54-56.
[http://dx.doi.org/10.4103/0971-4065.136883] [PMID: 25684874]
[25]
Segal, R.; Lubart, E.; Leibovitz, A.; Berkovitch, M.; Habot, B.; Yaron, M.; Caspi, D. Early and late effects of low-dose aspirin on renal function in elderly patients. Am. J. Med., 2003, 115(6), 462-466.
[http://dx.doi.org/10.1016/S0002-9343(03)00436-4] [PMID: 14563503]
[26]
Meek, I.L.; Van de Laar, M.A.F.J.; E., Vonkeman H. Non-steroidal anti-inflammatory drugs: An overview of cardiovascular risks. Pharmaceuticals (Basel), 2010, 3(7), 2146-2162.
[http://dx.doi.org/10.3390/ph3072146] [PMID: 27713346]
[27]
Hörl, W.H. Nonsteroidal anti-inflammatory drugs and the kidney. Pharmaceuticals (Basel), 2010, 3(7), 2291-2321.
[http://dx.doi.org/10.3390/ph3072291] [PMID: 27713354]
[28]
Schoenfeld, A.J.; Grady, D. Adverse effects associated with proton pump inhibitors. JAMA Intern. Med., 2016, 176(2), 172-174.
[http://dx.doi.org/10.1001/jamainternmed.2015.7927] [PMID: 26751904]
[29]
Fossmark, R.; Martinsen, T.C.; Waldum, H.L. Adverse effects of proton pump inhibitors-evidence and plausibility. Int. J. Mol. Sci., 2019, 20(20), E5203.
[http://dx.doi.org/10.3390/ijms20205203] [PMID: 31640115]
[30]
Moledina, D.G.; Perazella, M.A. PPIs and kidney disease: From AIN to CKD. J. Nephrol., 2016, 29(5), 611-616.
[http://dx.doi.org/10.1007/s40620-016-0309-2] [PMID: 27072818]
[31]
Al-Aly, Z.; Maddukuri, G.; Xie, Y. Proton pump inhibitors and the kidney: Implications of current evidence for clinical practice and when and how to deprescribe. Am. J. Kidney Dis., 2020, 75(4), 497-507.
[http://dx.doi.org/10.1053/j.ajkd.2019.07.012] [PMID: 31606235]
[32]
Griffin, K.A.; Bidani, A.K. Potential risks of calcium channel blockers in chronic kidney disease. Curr. Cardiol. Rep., 2008, 10(6), 448-455.
[http://dx.doi.org/10.1007/s11886-008-0071-8] [PMID: 18950553]
[33]
Sontrop, J.M.; Dixon, S.N.; Garg, A.X.; Buendia-Jimenez, I.; Dohein, O.; Huang, S.H.S.; Clark, W.F. Association between water intake, chronic kidney disease, and cardiovascular disease: A cross-sectional analysis of NHANES data. Am. J. Nephrol., 2013, 37(5), 434-442.
[http://dx.doi.org/10.1159/000350377] [PMID: 23594828]
[34]
Yoran, C.; Yellin, E.L.; Becker, R.M.; Gabbay, S.; Frater, R.W.; Sonnenblick, E.H. Dynamic aspects of acute mitral regurgitation: Effects of ventricular volume, pressure and contractility on the effective regurgitant orifice area. Circulation, 1979, 60(1), 170-176.
[http://dx.doi.org/10.1161/01.CIR.60.1.170] [PMID: 445720]
[35]
Grose, R.; Strain, J.; Cohen, M.V. Pulmonary arterial V waves in mitral regurgitation: Clinical and experimental observations. Circulation, 1984, 69(2), 214-222.
[http://dx.doi.org/10.1161/01.CIR.69.2.214] [PMID: 6690094]
[36]
Jawad, I.A.; Ghali, M.H.; Brown, R.L.; Sohn, Y.H. Pressure-flow relations across the normal mitral valve. Am. J. Cardiol., 1987, 59(8), 915-918.
[http://dx.doi.org/10.1016/0002-9149(87)91119-2] [PMID: 2950751]
[37]
Wathen, R.L.; Selkurt, E.E. Intrarenal regulatory factors of salt excretion during renal venous pressure elevation. Am. J. Physiol., 1969, 216(6), 1517-1524.
[http://dx.doi.org/10.1152/ajplegacy.1969.216.6.1517] [PMID: 5786741]
[38]
Mullens, W.; Abrahams, Z.; Francis, G.S.; Sokos, G.; Taylor, D.O.; Starling, R.C.; Young, J.B.; Tang, W.H.W. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J. Am. Coll. Cardiol., 2009, 53(7), 589-596.
[http://dx.doi.org/10.1016/j.jacc.2008.05.068] [PMID: 19215833]

Rights & Permissions Print Cite
Article Metrics
40
1
© 2024 Bentham Science Publishers | Privacy Policy