A case of rhabdomyolysis complicated with acute renal failure after resumption of fenofibrate therapy: A first report
A 51-year-old female patient with generalized muscle weakness, fatigue, and dark urine was admitted to the out-patient clinic of our hospital. The medical history revealed that she was on fenofibrate therapy (initial dose of 250 mg/day) for 2 years for her hypertriglyceridemia. In Turkey, fenofibrate are marketed as capsules of 250 mg or 267 mg micro pellets which make titration of the drug impossible. She neglected a refill of the initial prescription and ceased her therapy with fenofibrate for a month. Her laboratory analysis revealed a high triglyceride level and her doctor prescribed the same brand of fenofibrate with the same dosage (250 mg/day) two weeks before she was admitted to our hospital. Patient also had associated Hypertension treated with 5 mg/day of ramipril since 5 years. On Physical examination, she had disclosed 3/5 reduced muscle strength in her upper left extremities, 2/5 in the lower extremities reduced muscle strength with reduced deep tendon reflexes. No other pathology was detected. Laboratory findings at presentation were as follows: Creatine kinase:9627 IU/L (normal: 33-211 IU/L), aspartate aminotransferase: 188 IU/L (normal: 7-38), alanine aminotransferase: 68 IU/L (normal: 7-35), lactate dehydrogenase: 785 IU/L (normal: 80-245), serum creatinine: 1.49 mg/dL (normal: 0.6-1.2), blood urea nitrogen: 56 mg/dl (normal: 8-23). No other abnormal laboratory findings were found []. A complete ultrasound of the abdomen was normal.\nThe case was diagnosed as rhabdomyolysis complicated with renal failure, secondary to use of fenofibrate. Fenofibrate therapy was withdrawn; fluid resuscitation, and urine alkalization were performed and no hemodialysis was required. The patient's complaints and laboratory abnormalities were resolved at day 7 after hospitalization. She was discharged and monitored as an outpatient [].