Kidney Week

Abstract: PUB006

A Case of Rhabdomyolysis with AKI After Switching from Simvastatin to Rosuvastatin: A Rare Occurrence

Session Information

• Publication Only

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Quasem, Mohammad A., United Health Services Hospitals Inc, Binghamton, New York, United States

Mohammad A. Quasem, MD

• Jayaraman, Venkatesh, United Health Services Hospitals Inc, Binghamton, New York, United States

Venkatesh Jayaraman, MD

• Ahmed, Waqar, United Health Services Hospitals Inc, Binghamton, New York, United States

Waqar Ahmed

• Choudhry, Zaima Zaeem Ul Hameed, United Health Services Hospitals Inc, Binghamton, New York, United States

Zaima Zaeem Ul Hameed Choudhry, MD

• Gurunathan, Obuli Srinivasan, United Health Services Hospitals Inc, Binghamton, New York, United States

Obuli Srinivasan Gurunathan, MD

Introduction

Rhabdomyolysis is a well-documented side effect of statin therapy. The risk varies with the type of statin used, lipophilic statins particularly simvastatin is associated with higher risk of rhabdomyolysis in comparison to hydrophilic statins like rosuvastatin.
Here we describe a case of rhabdomyolysis complicated by AKI after switching from simvastatin to rosuvastatin, a rare occurrence.

Case Description

64-year-old female presented to emergency department (ED) on 03/11/2026 for abnormal labs. She was having low appetite for few days before presention. Has history of diabetes mellitus on metformin. Has history of hyperlipidemia was taking Simvastatin 40 mg daily for long time, switched to rosuvastatin 40 mg daily on 01/28/2026 (about 6 weeks before presentation). Labs in the ED showed, serum creatinine 4.8 GFR 9 (baseline serum creatinine around 1.4 (reference range 0.51-0.95 mg/dl), GFR 42.Creatine kinase was 1803 (reference range 0-170 U/L).

Discussion

Rhabdomyolysis is a well-recognized complication of statin use.
Primary mechanism of rhabdomyolysis due to statin therapy not clear but likely due to reduced production of ubiquinone (coenzyme Q). The HMG CoA pathway produces cholesterol and ubiquinone. Ubiquinone is a component of mitochondrial respiratory chain, needed for mitochondrial electron transport. Reduced production of ubiquinone disrupts cellular energy production causing muscle cell death.

Among statins lipophilic statins like simvastatin, atorvastatin and fluvastatin have higher toxic effectsd than hydrophilic statins like rosuvastatin and pravastatin. Simvastatin has the highest incidence of rhabdomyolysis in published case reports. However our patient was tolerating simvastatin well without any adverse effect but developed rhabdomyolysis complicated by AKI after switching to rosuvastatin (a stain with lower incidecnce of rhabdomyolysis according to published case reports), an unusual occurrence.

The risk of rhabdomyolysis increases with combination of other drugs (Inhibitors of cytochrome P450–3 A4) and risk factors includig age, >65 years (our patient 64 years old), females (our patient), chronic kidney disease (our patient, baseline GFR 42), liver disease and strenuous exercise.
This case highlights the need for awareness of rhabdomyolysis in patients taking statins even those reported lower risk of rhabdomyolysis like rosuvastatin and pravastain.