Affiliation:
1. Department of Emergency and Organ Transplantation, Unit of Cardiovascular Diseases, University of Bari, Bari, Italy
Abstract
Background:
We report the case of a 93-year-old patient with normal left ventricular function and severe mitral annulus calcification, with mild mitral steno-insufficiency.
Case Presentation:
She had developed creeping drugs-induced renal toxicity that is generally totally overlooked, due mainly to statins, a proton pump inhibitor, and aspirin. The Na and fluid retention, along with hypertension that ensued, although not severe, caused acute heart failure (sub-pulmonary edema) by worsening the mitral insufficiency. This occurred due to a less effi-cient calcific mitral annulus contraction during systole and an increasing mitral transvalvular gra-dient, as the transvalvular mitral gradient has an exponential relation to flow. After the suspension of the nephrotoxic drugs and starting intravenous furosemide, she rapidly improved. At 6 months follow-up, she is stable, in an NYHA 1-2 functional class, despite the only partial recovery of the renal function.
Conclusion:
Progressive renal failure can functionally worsen even minimal mitral valvulopathy. Drug-induced nephrotoxicity can always be suspected in case of renal failure of unknown etiol-ogy. The suspension of the culprit drugs can improve renal function and dramatically improve the clinical symptoms even in a nonagenarian.
Publisher
Bentham Science Publishers Ltd.
Subject
Immunology and Allergy,Endocrinology, Diabetes and Metabolism
Reference38 articles.
1. Roger V.L.; Epidemiology of heart failure. Circ Res 2013,113(6),646-659
2. Verdoodt A.; Honore P.M.; Jacobs R.; De Waele E.; Van Gorp V.; De Regt J.; Spapen H.D.; Do statins induce or protect from acute kidney injury and chronic kidney disease: An update review in 2018. J Transl Int Med 2018,6(1),21-25
3. Perazella M.A.; Renal vulnerability to drug toxicity. Clin J Am Soc Nephrol 2009,4(7),1275-1283
4. Perazella M.A.; Toxic nephropathies: Core curriculum 2010. Am J Kidney Dis 2010,55(2),399-409
5. Pazhayattil G.S.; Shirali A.C.; Drug-induced impairment of renal function. Int J Nephrol Renovasc Dis 2014,7,457-468
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献