Abstract: SA-PO282
Varenicline Associated Acute Interstitial Nephritis
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 103 AKI: Mechanisms
Authors
- Salam, Hamza, Wayne State University, Detroit, Michigan, United States
- Jawed, Areeba, Wayne State University, Detroit, Michigan, United States
Introduction
Varenicline is a nicotinic receptor partial agonist with proven benefits in smoking cessation. It is not known to cause renal toxicity. 2 case reports describe acute insterstitial nephritis (AIN) due to varenciline with pre-existing renal impairment. We describe a case with normal renal function who presented with acute renal failure soon after starting varenicline.
Case Description
59-year-old male with history of HIV, hepatitis C, hyperthyroidism, hypertension and diabetes mellitus. Patient presented with worsening lower extremity edema. He was on HAART therapy with darunavir, etravirine and raltegravir. Other medications included amlodipine, lisinopril, metformin, glipizide, terazosin and varenicline. Varenicline was started 1 month prior to presentation and was the only new medication. Patient had normal kidney function at baseline serum creatinine (sCr) 1.1 as per labs drawn 2 months prior. Physical exam showed a middle-aged man with normal vitals, bilateral pitting edema up to the ankles, mild abdominal distension. Initial labs showed sCr 6.5, BUN 60, albumin 3, normal CBC, LFTs, lipase and CPK. On Urinalysis, blood 2+, protein 300, WBC 20-50, WBC esterase 1+, . Spot urine protein to creatinine ratio was 6.5. Ultrasound showed subtle hypoechoic bilateral renal pyramids with increased echogenicity in the renal parenchyma possibly related to underlying renal disease or inflammation. Patient was started on intermittent hemodialysis due to declining urine output and uremia. A renal biopsy was performed during admission that confirmed acute interstitial nephritis. Varenciline was held, patient was started on steroids. Renal function began improving and dialysis was stopped. sCr returned to baseline at clinic follow up.
Discussion
This is only the third case describing Varenciline associated AIN. A careful medication history with biopsy was essential in diagnosing cause for kidney injury in this patient with multiple comorbidities.