scholarly journals Rhabdomyolysis: a rare adverse effect of levetiracetam

2019 ◽  
Vol 12 (8) ◽  
pp. e230851 ◽  
Author(s):  
Liza Thomas ◽  
Madiha Muhammed Farooq Mirza ◽  
Niaz Ahmed Shaikh ◽  
Nahla Ahmed

A 62-year-old previously healthy male was admitted with new onset generalised tonic-clonic seizures. Treatment was initiated with the antiepileptic levetiracetam and he had no further episodes of seizures. Creatine kinase (CPK) level was 1812 IU/L 12-hour postadmission. Despite good hydration, his CPK levels continued to rise dramatically and reached a level of 19 000 IU/L on day 5. This rise was unexplained as he did not have any further seizures and had a normal renal function. In the absence of other risk factors, the rare possibility of levetiracetam being responsible for the disproportionately high CPK was considered. Within 12 hours of withdrawal of levetiracetam, there was a downward trend in the CPK levels, with a 10-fold decrease in CPK levels over the next 4 days. This is only the ninth case reported in literature regarding this rare and potentially serious adverse effect of levetiracetam.

2008 ◽  
Vol 25 (Sup 44) ◽  
pp. 12
Author(s):  
S. Sabate ◽  
Z. Briones ◽  
C. Gomar ◽  
J. Canet ◽  
J. Campos

2021 ◽  
Author(s):  
Tomohiro Kaneko ◽  
Eitaro Kodani ◽  
Hitomi Fujii ◽  
Risa Asai ◽  
Miyako Seki ◽  
...  

Abstract Background Various risk factors have been identified for the new-onset or rapid deterioration of chronic kidney disease. However, it is thought that many risk factors that have not yet been clarified remain. Methods Based on the results of specific annual health checkups at Tama City (n = 18,383) in 2017 and 2018, we analyzed the factors that cause new-onset chronic kidney disease and the risk factors that rapidly worsen renal function. For new-onset chronic kidney disease, proteinuria and estimated glomerular filtration rate < 60 mL/min/1.73m2 were examined separately. Rapid deterioration of renal function was defined as an estimated glomerular filtration rate of ≥ 25% lower than the previous year. Results Multivariate analysis showed that, in addition to age and impaired glucose tolerance, anemia, and atrial fibrillation were risk factors for the new appearance of proteinuria. Risk factors for a decrease in estimated glomerular filtration rate < 60 mL/min/1.73m2 were age and hyperuricemia. Age, systolic hypertension, urinary protein and urinary occult blood, high triglycerides, and anemia were significant risk factors for the rapid deterioration of renal function in patients with chronic kidney disease stage 3 or later. Conclusions From the results of specific annual health checkups at Tama City, atrial fibrillation, anemia, and hyperuricemia were identified as risk factors for new-onset chronic kidney disease over a short period of 1 year. Anemia was also a factor for the rapid deterioration of kidney function in subjects with renal dysfunction.


Author(s):  
Shirelle Assaram ◽  
Tivani P. Mashamba-Thompson ◽  
Nombulelo P. Magula

Introduction: Our systematic scoping review has demonstrated a research gap in antiretroviral treatment (ART) nephrotoxicity as well as in the long-term outcomes of renal function for patients on ART in South Africa. Bearing in mind the high prevalence of human immunodeficiency virus (HIV) in South Africa, this is of great concern.Objectives: To determine the risk factors and co-morbidities associated with changes in renal function in HIV-infected adults in South Africa.Methods: We conducted a retrospective study of 350 ART-naïve adult patients attending the King Edward VIII HIV clinic, Durban, South Africa. Data were collected at baseline (pre-ART) and at six, 12, 18 and 24 months on ART. Renal function was assessed in the 24-month period using the Modification of Diet in Renal Disease equation and was categorised into normal renal function (estimated glomerular filtration rate [eGFR] ≥ 60), moderate renal impairment (eGFR 30–59), severe renal impairment (eGFR 15–29) and kidney failure (eGFR < 15 mL/min/1.73 m2). Generalised linear models for binary data were used to model the probability of renal impairment over the five time periods, controlling for repeated measures within participants over time. Risk ratios and 95% confidence intervals (CI) were reported for each time point versus baseline.Results: The cohort was 64% female, and 99% were Black. The median age was 36 years. At baseline, 10 patients had hypertension (HPT), six had diabetes, 61 were co-infected with tuberculosis (TB) and 157 patients had a high body mass index (BMI) with 25.4% being categorised as overweight and 19.4% as obese. The majority of the patients (59.3%) were normotensive. At baseline, the majority of the patients (90.4%) had normal renal function (95% CI: 86% – 93%), 7.0% (CI: 5% – 10%) had moderate renal impairment, 1.3% (CI: 0% – 3%) had severe renal impairment and 1.3% (CI: 0% – 3%) had renal failure. As BMI increased by one unit, the risk of renal impairment increased by 1.06 (CI: 1.03–1.10) times. The association of HPT with abnormal renal function was found to be insignificant, p > 0.05. The vast majority of patients were initiated on tenofovir disoproxil fumarate (TDF) (90.6%), in combination with lamivudine (3TC) (100%) and either efavirenz (EFV) (56.6%) or nevirapine (NVP) (43.4%).Conclusion: This study reports a low prevalence of baseline renal impairment in HIV-infected ART-naïve outpatients. An improvement in renal function after the commencement of ART has been demonstrated in this population. However, the long-term outcomes of patients with HIV-related renal disease are not known.


2019 ◽  
Vol 7 ◽  
pp. 2050313X1987419
Author(s):  
Syed W Habib

Anti-neutrophil cytoplasmic antibody–associated crescentic glomerulonephritis commonly presents as a renal emergency requiring timely care to reduce risk of kidney failure and related mortality. Milder forms of disease are less common, and it requires a high index of suspicion to detect them. Herein, we report a case of focal proliferative and necrotizing glomerulonephritis in a 21-year-old patient presenting with a new-onset microscopic haematuria and minimal proteinuria associated with normal renal function.


Author(s):  
Nicole Giunio-Zorkin ◽  
Glen Brown

<p><strong>ABSTRACT</strong><br /><strong></strong></p><p><strong>Background:</strong> Thrombocytopenia is a well-recognized adverse effect of linezolid; however, the frequency of this adverse effect during therapy has been variable across previous studies, and the associated risk factors are unclear. <br /><strong></strong></p><p><strong>Objectives:</strong> To identify the real-life frequency of new-onset thrombo -cytopenia due to linezolid and to determine the associated risk factors. <br /><strong>Methods:</strong> A retrospective observational cohort study was conducted among consecutive inpatients at a tertiary care hospital who received linezolid for a minimum of 5 days between January 2013 and August 2017. Data were extracted from electronic medical records obtained from a hospital database. Thrombocytopenia was defined as platelet count less than 100 × 109/L or a 50% reduction from baseline (i.e., before linezolid initiation). Risk factors were identified by comparing the characteristics of patients who experienced the adverse effect during linezolid therapy with those of patients who did not experience the adverse effect. Continuous data were analyzed with the t test and categorical data with the 2 test. <br /><strong></strong></p><p><strong>Results:</strong> A total of 102 patients were included (38 women, 64 men; overall mean age 50 years, standard deviation [SD] 21). The mean duration of linezolid therapy was 14 (SD 10) days. Thrombocytopenia occurred in 18 patients (17.6%). Risk factors for the development of thrombocytopenia included mean duration of therapy (22 [SD 18] days versus 12 [SD 7] days; p = 0.023), renal replacement therapy (17% versus 4%; p = 0.032), renal impairment (61% versus 32%; p = 0.021), and concomitant administration of unfractionated heparin (50% versus 21%; p = 0.013). <br /><strong></strong></p><p><strong>Conclusions:</strong> The real-life frequency of new-onset of thrombocytopenia in patients receiving linezolid for a minimum of 5 days was 17.6%. Risk factors for linezolid-induced thrombocytopenia included prolonged duration of therapy, renal impairment, and concomitant unfractionated heparin.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> La thrombopénie est une réaction indésirable bien connue, induite par le linézolide; cependant, la fréquence de cette réaction indésirable pendant le traitement hvariait d’une étude à l’autre et on ignore quels sont les facteurs de risque associés à cet antibiotique. <br /><strong></strong></p><p><strong>Objectifs :</strong> Découvrir la fréquence réelle des nouveaux cas de thrombopénie causés par le linézolide et déterminer les facteurs de risque qui lui sont associés. <br /><strong></strong></p><p><strong>Méthodes :</strong> Une étude de cohorte observationnelle rétrospective a été menée auprès de patients hospitalisés consécutivement dans un hôpital de soins tertiaires, qui ont reçu du linézolide pendant au moins cinq jours entre janvier 2013 et août 2017. Les données ont été tirées des dossiers médicaux électroniques provenant d’une base de données d’un hôpital. La thrombopénie a été définie comme un taux de plaquettes de moins de 100 × 109/L ou comme une réduction de 50 % de leur valeur initiale (c’est-à-dire, avant l’amorce du traitement au linézolide). Les chercheurs ont établi les facteurs de risque en comparant les caractéristiques des patients ayant subi la réaction indésirable pendant leur traitement au linézolide avec les caractéristiques des patients n’ayant pas subi cet effet indésirable. Les données continues ont été analysées à l’aide d’un test t et les données catégoriques à l’aide d’un test de 2. <br /><strong></strong></p><p><strong>Résultats :</strong> Au total, 102 patients ont été admis (38 femmes, 64 hommes; âge moyen de 50 ans, écart-type de 21). La durée du traitement au linézolide était de 14 jours (écart-type de 10). Dix-huit patients (17,6 %) ont souffert de thrombopénie. Parmi les facteurs de risque de thrombopénie, on comptait la durée moyenne du traitement (22 jours [écart-type de 18] contre 12 jours [écart-type de 7]; p = 0,023), le traitement de suppléance rénale (17 % contre 4 %; p = 0,032), l’insuffisance rénale (61 % contre 32 %; p = 0,021) et l’administration concomitante d’héparine non fractionnée (50 % contre 21 %; p = 0,013). <br /><strong></strong></p><p><strong>Conclusions :</strong> La fréquence réelle de nouveaux cas de thrombopénie parmi les patients recevant du linézolide pendant un minimum de 5 jours était de 17,6 %. Parmi les facteurs de risque de thrombopénie associés au linézolide, on mentionne l’allongement de la durée du traitement, l’insuffisance rénale et l’administration concomitante d’héparine non fractionnée.</p><p> </p>


2016 ◽  
Vol 30 (6) ◽  
pp. 650-652 ◽  
Author(s):  
Laura J. Baumgartner ◽  
Lauren Brown ◽  
Curt Geier

Systemic absorption of oral vancomycin for the treatment of Clostridium difficile is thought to be trivial in patients without risk factors for increased systemic absorption and is often overlooked in clinical practice. A 51-year-old male elicits a suspected immunoglobulin E-mediated hypersensitivity following administration of low-dose oral vancomycin for the treatment of severe C difficile. The patient had normal renal function and was administered low doses of the medication, however, had a medical history significant for diverticulitis. Applying the Naranjo adverse drug reaction probability scale, a score of 5 was obtained, indicating a probable association between the administration of oral vancomycin and the hypersensitivity reaction. This case demonstrates that hypersensitivity reactions following low-dose oral vancomycin administration in patients with severe C difficile are possible, despite having normal renal function. Other risk factors for systemic absorption of oral vancomycin need to be evaluated in the literature, including severity of disease and underlying gastrointestinal processes.


Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 500-P
Author(s):  
MINGXIA YUAN ◽  
SHENYUAN YUAN ◽  

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