Acute renal failure secondary to rhabdomyolysis in a patient receiving treatment with ticagrelor and atorvastatin

摘要

It is rapidly captured by the cells through the ENT and CNT transporters (equilibrium and concentrative nucleoside transporters). It has a general vasodilating action, but in the kidneys its action depends on its concentration, and it can be vasoconstrictive, which is essential in the glomerular tubular feedback mechanism, or vasodilator. At low concentrations, it stimulates receptor 1 (and to a lesser extent 3), which causes the inhibition of adenylyl cyclase, and cAMP, potentiating the effect of angiotensin II and inducing vasoconstriction (VSC) of the afferent arteriole (AA) by stimulating purinergic recep- tors (P2) of mesangial cells and AA and inhibition of renin secretion, which helps maintain the autoregulation of renal blood flow (RBF).'*'? At higher doses, receptor 2, mainly 2B, is stimulated. This is expressed in juxtamedullary preglomeru- lar vessels, and increases the concentration of cAMP, inducing vasodilatation (VSD) of the AA and reducing the efficacy of the autoregulatory mechanism. Even at higher concentration, the predominant effect is stimulation of 2A receptors with VSD of the efferent arteriole (EA), which causes a reduction in FSR and the glomerular filtration rate (GFR) (Fig. 1). In these cases, it is recommended to replace atorvastatin with fluvastatin, which is metabolised by P459 CYP 2C9, and ticagrelor with clopidogrel. Several similar cases have been described in the literature??.°.!*1° with ticagrelor and different statins used at adequate doses. In the majority, the clinical picture presents after a period of 1-3 months of use of these drugs. In our case, both the increased adenosine due to inhibition of the ENT1 transporter and the stimulus due to ischaemic injury could have caused renal damage with accumulation of the statin, even though the doses used were correct. This compels us to reassess this recommendation in situations of polypharmacy, clinical instability or special fragility of patients.