Abstract: PUB643
Valerian Root Interaction with Statins: Another Cause of Rhabdomyolysis-Associated AKI
Session Information
Category: Nephrology Education
- 1302 Fellows and Residents Case Reports
Authors
- Borrero-Arvelo, Alexander, Veterans Affairs Caribbean Healthcare System, Toa Baja, Puerto Rico, United States
- Acosta Oruna, Enrique E., Internal Medicine Resident, San Juan, Puerto Rico, United States
- Coppola fasick, Stefano, VA Caribbean healthcare system, Guaynabo, Puerto Rico, United States
- Loyola, Jacobo Josue, Veterans Affairs Caribbean Healthcare System, Toa Baja, Puerto Rico, United States
- Rodriguez, Eddie M., Veterans Affairs Caribbean Healthcare System, Toa Baja, Puerto Rico, United States
- Cruz rodriguez, Migdoel, VA healthcare system, Patillas, Puerto Rico, United States
- Perez-Lopez, Carlos Juan, VA caribbean Healthcare sytem, San juan, Puerto Rico, United States
- Morales, Lorena D, VA caribbean Healthcare System , San Juan, Puerto Rico, United States
- Soto, Elvin, VA Caribbean Healthcare System, San Juan, Puerto Rico, United States
- Rosado-Rodriguez, Carlos S., Veterans Affairs Caribbean Healthcare System, Toa Baja, Puerto Rico, United States
Background
Valerian root is an herbal supplement used to treat insomnia, anxiety and muscle tension. It has a complex mixture of chemical compounds including valeric acid and its derivatives. Valeriana root has been shown to decreased the CYP3A gene expression by nuclear receptors in an experimental model but interactions with drugs metabolized by the CYP450 has not been clearly established. We report a patient who presented with severe rhabdomyolysis and oliguric acute renal failure coincident with the use of Valerian root and Rosuvastatin.
Methods
An 88 year old man was brought to the ED with 3 day history of general malaise, hypoactivity, poor oral intake and decrease urine output. He had history of CKD Stage 3b associated to HTN, T2DM, CVA with residual right hemiparesis, prostate hypertrophy, and hyperlipidemia. He was on Rosuvastatin, Losartan and Terazosin. No recent medication dose changes was documented. He was also taking Melatonin and Valerian root herbal supplement for insomnia. Vital signs: BP: 110/70 HR: 60/min. The patient was alert, but disoriented. Physical exam was remarkable for bilateral leg pitting edema. Initial laboratory data at the ED revealed: S Creat: 14.9, BUN 118 mg/dl, and Glucose: 216 mg/dl; Na: 123 K: 8.6, Cl: 90, TCO2: 15 meq/l. Blood pH: 7.20 pCO2: 37.3. Elevated total CPK(See Table). Urinalysis was not taken since anuria. A diagnosis of acute kidney injury due to rhabdomyolysis was made. The patient required acute RRT. There were no signs of urinary tract obstruction in imaging studies. Clinical picture was complicated by development of respiratory failure due to bilateral pneumonia. He also had episode of allergic reaction to Sulfa. The patient was discharged home 3 weeks later on hemodialysis treatments since there no significant recovery of renal function.
Conclusion
Development of acute renal failure due to rhabdomyolysis may have been precipitated by Valerian root interaction with hepatic metabolism of Rosuvastatin.
| Day | S Creat (mg/dl) | Total CPK (IU/L) | Total Bilirubin (mg/dl) |
| 1 | 14.9 | >20,000 | 0.29 |
| 5 | 2.04 | 6441 | 1.18 |
| 16 | 5.10 | 182 | 0.48 |
Funding
- Veterans Affairs Support