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A 38 year old male is diagnosed with coronary artery disease and hypercholesterolemia. His family physician prescribes a him a series of medications to manage his CAD and hypercholesterolemia. Six weeks later he reports to the emergency department complaining of fatigue, nausea, and a reddish tint to his urine. Physical examination reveals a blood pressure of 150/90. Urinalysis reveals protein, granular casts, no RBCs, and a reddish brown coloration. A metabolic panel is done and he is found to have an elevated BUN (80 mg/dL) and creatinine (8 mg/dL). The attending physician declares the man to be in acute renal failure, and says that the renal damage is due to a drug he was given for his coronary artery disease. Which drug is this most likely to be?
A - Prazosin
B - Nitroglycerin
C - Spironolactone
D - Simvastatin
E - Propanolol
F - Nifedipine
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d...is right
This patient is suffering from acute tubular necrosis as evidenced by the granular casts in his urine and azotemia. The reddish tint of his urine which lacks RBCs is due to hemoglobin or myoglobin staining suggesting lysis of RBCs or muscle somewhere in the body. Statins are a commonly prescribed drug in patients with CAD and hypercholesterolemia and can presents with a side effect of rhabdomyolysis. Myoglobin is released from the lysed muscle cells and filtered by the kidney. Myoglobin is intrinsically toxic to tubular epithelial cells and capable of causing ATN.
A – Prazosin is an α1 selective antagonist that can cause 1st dose orthostatic hypertension, headache, and dizziness.
B – Nitroglycerin causes venodilation and a decrease in preload with side effects of tachycardia, hypotension, flushing, and headache.
C – Spironolactone is a K+ sparing diuretic with side effects of hyperkalemia and gynecomastia.
E – Propanolol is a non-selective ?-blocker with side effects of impotence, bradycardia, AV block, bronchoconstriction in asthmatics, sedation, and CHF.
F – Nifedipine is an L-type Ca++ channel blocker in smooth and cardiac muscle with side effects of dizziness, flushing, and nausea.
