Severe recurrent rhabdomyolysis-induced acute kidney injury in a HIV-infected patient on antiretroviral therapy

Figures & data

Figure 1. Light photomicrograph of kidney biopsy specimen stained with periodic acid-Schiff stain, showing intratubular casts under high power view (arrows).

Table 1. Reported cases of rhabdomyolysis that have been associated with tenofovir and/or abacavir in the literature.

Reference	No. of cases reported	HAART regimen	Confounding factors	Renal failure present?	Dialysis required?	Outcome
Tosini et al.3	1	Tenofovir/emtricitabine and lopinavir/ritonavir	None reported	No	N/A	CK normalized 7 days after discontinuation of medication
Mikhail et al.4	1	Atazonavir, ritonavir, emtricitabine, tenofovir	Statin (pravastatin) dose increased	No	N/A	CK normalized 10 days after discontinuation of statin and HAART
Parsonage et al.6	1	Abacavir, lamivudine, efavirenz	None reported	No	N/A	CK normalized following discontinuation of HAART
Callens et al.22	1	Lopinavir/ritonavir, saquinavir, abacavir, efuvirtide, tenofovir	Electrolyte disorders present: hypokalemia, hypophosphatemia	Yes	No	CK and potassium normalized 1 month after discontinuation of tenofovir, however, serum creatinine remained elevated
Shere-Wolfe et al.23	1	Efavirenz, stavudine, tenofovir	Statin (atorvastatin) use	No	N/A	CK levels improved following discontinuation of HAART

N/A, not applicable.

Tosini W, Muller P, Prazuck T, et al. Tolerability of HIV postexposure prophylaxis with tenofovir/emtricitabine and lopinavir/ritonavir tablet formulation. AIDS. 2010;24(15):2375–2380

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Mikhail N, Iskander E, Cope D. Rhabdomyolysis in an HIV-infected patient on anti-retroviral therapy precipitated by high-dose pravastatin. Curr Drug Saf. 2009;4(2):121–122

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Parsonage MJ, Barlow G, Lillie P, et al. Severe myositis on commencement of efavirenz, abacavir and lamivudine, in the absence of lactic acidosis or classical abacavir hypersensitivity. BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.01.2009.1411

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Callens S, De Roo A, Colebunders R. Fanconi-like syndrome and rhabdomyolysis in a person with HIV infection on highly active antiretroviral treatment including tenofovir. J Infect. 2003;47(3):262–263

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Shere-Wolfe KD, Verley JR. Marked elevation of the creatine phosphokinase level in a patient receiving tenofovir. Clin Infect Dis. 2002;35(9):1137

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