Behavioral Changes of Paranoia Associated with Atorvastatin; Hemolytic-Uremic Syndrome Associated with Gemcitabine; Daptomycin-Induced Acute Renal Failure and Hepatic Toxicity; Drug-Induced Liver Disease Related to Citalopram; Unexpected Acute Hepatic Injury in Patients Treated Repeatedly with Ketoconazole; Acute Hepatotoxicity Seen with Lamotrigine; Anticholinergic Adverse Effects in Elderly Patients

Objective: To report a case of acute hepatic injury associated with varenicline. Case Summary: A 53-year-old white male with underlying alcoholic liver disease and history of hepatitis C virus infection experienced elevated aminotransferase and alkaline phosphatase levels consistent with acute hepatic injury after initiation of varenicline for smoking cessation. The hepatic injury manifested 4 weeks after initiation of varenicline therapy at 0.5 mg once daily for 3 days, 0.5 mg twice daily for 4 days, and then 1 mg twice daily. Following discontinuation of varenicline, the patient's aminotransferase levels continued to rise for 2 days before steadily decreasing and returning to baseline levels in approximately 4 months. Alkaline phosphatase continued to rise for 8 days after discontinuation of varenicline before returning to baseline within 1 month. Rechallenge was not attempted. Discussion: Varenicline is a novel, first-line agent for smoking cessation. The presentation of this patient is most consistent with an acute hepatic injury related to drug toxicity. The pattern of the patient's elevated hepatic enzyme levels is not consistent with his underlying alcoholic liver disease or hepatitis C. Using the Naranjo probability scale, as well as the Counsel for International Organizations of Medical Science/Roussel Uclaf Causality Assessment Method algorithm for drug-induced liver toxicity, we determined that varenicline was the probable cause of the acute hepatic injury. Varenicline was a possible cause of the acute hepatic injury using the algorithm for drug-induced liver toxicity developed by Maria and Victorino. To our knowledge, this is the first report of acute hepatic injury associated with varenicline. Conclusions: While the benefits of smoking cessation are likely greater than the risk of hepatic injury, clinicians should be cognizant of this reaction associated with varenicline.

Download Full-text

Prognostic importance of vascular lesions in acute renal failure with microangiopathic hemolytic anemia (hemolytic-uremic syndrome): Clinicopathologic study in 20 adults

Kidney International ◽

10.1038/ki.1979.70 ◽

1979 ◽

Vol 15 (5) ◽

pp. 548-558 ◽

Cited By ~ 85

Author(s):

Liliane Morel-Maroger ◽

Alain Kanfer ◽

Kim Solez ◽

Jean-Daniel Sraer ◽

Gabriel Richet

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Hemolytic Uremic Syndrome ◽

Hemolytic Anemia ◽

Vascular Lesions ◽

Microangiopathic Hemolytic Anemia ◽

Clinicopathologic Study ◽

Uremic Syndrome ◽

Prognostic Importance

Download Full-text

Acute Renal Failure Due to Hemolytic Uremic Syndrome in Adult Patients

Renal Failure ◽

10.3109/08860229709026289 ◽

1997 ◽

Vol 19 (2) ◽

pp. 279-282 ◽

Cited By ~ 13

Author(s):

Yvoty A. S. Sens ◽

Luiz A. Miorin ◽

HÉLio G. C. Silva ◽

Denise M.A.C Malheiros ◽

Dino M. Filho ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Hemolytic Uremic Syndrome ◽

Adult Patients ◽

Uremic Syndrome

Download Full-text

Surgical complications of peritoneal dialysis in children with acute kidney failure

Pediatrician (St Petersburg) ◽

10.17816/ped11357-63 ◽

2020 ◽

Vol 11 (3) ◽

pp. 57-63

Author(s):

Dmitrii A. Dobroserdov ◽

Mikhail V. Shchebenkov ◽

Alexey L. Shavkin

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Peritoneal Dialysis ◽

North West ◽

The North ◽

Specialized Center ◽

Uremic Syndrome ◽

Specialized Department ◽

Dialysis Complications

The dialysis department of the Childrens City Multidisciplinary Clinical Specialized Center for High Medical Technologies has been operating since 1977 and is the only specialized department in the North-West Region of the Russian Federation that provides assistance to children with both acute and chronic renal failure. Peritoneal dialysis is the treatment of choice for children with acute renal failure, the most common cause of which is hemolytic-uremic syndrome. Despite widely used measures to improve the results of peritoneal dialysis, complications are extremely common. The article analyzes the complications of peritoneal dialysis in children with acute renal failure who were treated in a hospital from 2008 to 2018. The emphasis in the study is on the analysis of complications of peritoneal dialysis, in the treatment of which the surgeon actively participated or should have taken part in. If the problem of acute renal failure is multidisciplinary in the sense that it requires the participation of nephrologists, resuscitators, infectious disease specialists, then if necessary, renal replacement therapy requires the surgeon to become not only a specialist providing access, but also a full-fledged participant in the treatment process. As follows from the foregoing, the surgeons actions depend not only on the quality of dialysis, but also the timeliness and adequacy of treatment of complications, which ultimately improves or worsens the quality of medical care in general.

Download Full-text

Hemolytic-uremic syndrome: Findings of post-acute renal failure in light and electron microscopy

Ultrastructural Pathology ◽

10.1080/01913123.2017.1292436 ◽

2017 ◽

Vol 41 (3) ◽

pp. 227-233

Author(s):

Wiesława Salwa-Żurawska ◽

Jakub Żurawski ◽

Aldona Woźniak ◽

Elżbieta Bortkiewicz ◽

Paweł Burchardt ◽

...

Keyword(s):

Electron Microscopy ◽

Renal Failure ◽

Acute Renal Failure ◽

Hemolytic Uremic Syndrome ◽

Light And Electron Microscopy ◽

Uremic Syndrome

Download Full-text

Serum aminotransferase elevation during and following treatment of childhood acute lymphoblastic leukemia.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.4.1560 ◽

1997 ◽

Vol 15 (4) ◽

pp. 1560-1566 ◽

Cited By ~ 28

Author(s):

A C Farrow ◽

G R Buchanan ◽

R J Zwiener ◽

W P Bowman ◽

N J Winick

Keyword(s):

Liver Disease ◽

Acute Lymphoblastic Leukemia ◽

Hepatic Injury ◽

Clinical Evidence ◽

Lymphoblastic Leukemia ◽

Dose Intensity ◽

Protocol Design ◽

Hepatic Toxicity ◽

Serum Aminotransferase ◽

Normal Alt

PURPOSE The clinical significance of methotrexate (MTX)-induced hepatic toxicity in children with acute lymphoblastic leukemia (ALL) is poorly defined. Therefore, we conducted a study to determine whether intensive MTX therapy could be safely delivered despite isolated serum ALT elevations in children with ALL. PATIENTS AND METHODS A total of 243 children with B-precursor ALL were treated with extended pulses of oral divided-dose MTX (dMTX). Serum ALT levels were measured approximately every 7 weeks during therapy, as well as after its cessation. By protocol design, treatment was continued without modification in the presence of ALT elevations if there was no other evidence of liver dysfunction. RESULTS Of 239 assessable patients, 159 (66.5%) had an ALT level > or = 180 IU/L during therapy and 28 patients (17.6%) had one or more values > or = 720 IU/L. After the completion of therapy, only 17 of 104 assessable patients have had one or more elevated ALT value. Eight of these 17 patients (47%) are hepatitis C virus (HCV)-seropositive. The remaining nine children had subsequent normal or near normal ALT values, and none have clinical evidence of liver disease. CONCLUSION Our data show that MTX can be safely delivered without dose modification in patients with isolated ALT elevations and that continued therapy does not lead to clinically apparent liver disease. ALT elevations are not a reliable predictor of the presence or extent of hepatic injury, and persistently increased ALT values following the completion of ALL therapy are rare in the absence of HCV infection. Continued MTX therapy allows for increased dose-intensity and may improve outcome in children with ALL.

Download Full-text