Rosuvastatin-Induced Rhabdomyolysis: A Silent Culprit of Acute Kidney Injury.

Abstract

Background

Statins are widely used for the prevention of atherosclerotic cardiovascular disease and are generally well tolerated. However, statin-associated muscle symptoms (SAMS), including rhabdomyolysis, remain rare but potentially life-threatening adverse effects. Rosuvastatin, a high-potency statin, has been associated with an increased risk of rhabdomyolysis, particularly in elderly individuals, patients with renal impairment, and Asian populations with altered pharmacogenetic profiles. We report a biopsy-proven case of rosuvastatin-induced rhabdomyolysis leading to pigment nephropathy and severe acute kidney injury (AKI).

Case Report

A L We report a case of a 64 years old male with a history of multiple vascular comorbidities, who was switched from 40 mg atorvastatin to 40 mg of rosuvastatin daily. Two months later, the patient presented with renal failure and severe myopathy. On evaluation, creatinine and liver enzymes were elevated. Rhabdomyolysis was suspected and supported by markedly elevated creatine phosphokinase (CPK) levels (25,745 IU/L). Renal biopsy showed features of pigment nephropathy. Despite initial supportive care therapy, haemodialysis was required. Rosuvastatin induced rhabdomyolysis was suspected and the drug was discontinued. Patient became dialysis-independent after 2 weeks with gradual partial recovery of renal function.

Conclusion

This biopsy-proven case demonstrates high dose rosuvastatin induced rhabdomyolysis with acute kidney injury (AKI) in an elderly patient without documented pre-existing chronic kidney disease. It highlights the need for individualized dosing and careful monitoring, particularly in elderly and Indian populations who maybe more susceptible to statin toxicity. Early recognition and prompt discontinuation of the offending agent are crucial to prevent irreversible renal damage and optimize patient outcomes.