Abstract: PUB570
A Case of CKD Mimicry
Session Information
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Sedlacek, Martin, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Graber, Martha L., Dartmouth College, Hanover, New Hampshire, United States
Introduction
CKD is treated with medications to delay disease progression, resulting in an increase in serum creatinine that is expected and beneficiel. Here we present the case of a patient who complained of lightheadedness and palpitations while he was treated for CKD. After stopping valsartan and fenofibrate his kidney function returned to normal with no sign of kidney disease for several years.
Case Description
A 56 y/o man was referred for stage 4 CKD since about 9 months in the context of type 2 diabetes mellitus, HTN, dyslipidemia and a history of colonic polyps and hand surgery. His diabetes was diet controlled with his last HbA1c 6.1%. He was treated with valsartan 320mg daily for years. His other medications were fenofibrate 145mg daily, rosuvastatin 10mg daily and ASA 325mg daily. There was no history of severe illness, radiocontrast studies or NSAID use. BP was 131/81 and he was overweight. Urinalysis and urine sediment were normal and there was no microalbuminuria. Laboratory tests were negative for complications of CKD. Renal ultrasound and Duplex were normal. The patient complained of dizziness and palpitations and underwent a cardiology evaluation which was negative. The patient stopped Valsartan himself and his symptoms resolved. HTN was treated with Atenolol. His serum creatinine improved and for the next years he had no more evidence of kidney disease with normal blood and urine testing (figure 1).
Discussion
The clinical diagnosis of CKD depends on blood and urine tests which can be affected by medications. The patient had a lasting but reversible creatinine increase by valsartan (hemodynamic effect) and fenofibrate (increased creatinine generation). Rosuvastatin has been associated with hematuria and albuminuria (not in this patient). Patient complaints of medication side effects are statistically non significant in most CKD studies, often implying that they might not be relevant for treatment decisions. This case shows that in the individual patient, ignoring symptoms of medication side effects can lead to morbidity and even iatrogenic disease.