Urinary lithiasis is a common disease, prevalence rates vary from 1% to 20%, according to gender, dietary, ethnic, the geographical, and genetic factors.

Introduction: Statins are the drugs of choice to reduce cholesterol and the incidence of cardiovascular events. Although rare, the side effects of these drugs may be severe (especially when given in the high doses recommended by the cardiologists), including: muscle damage, renal and liver injury and compromised function, and polyneuropathy.

Case Report: We report a case of statin-induced rhabdomyolysis, acute kidney and liver failure and thrombocytopenia that developed in a 76-year-old man, who was referred to our department because of severe generalized myalgia and muscle weakness, extreme fatigue, loss of appetite, dark brown urine. Following an acute myocardial infarction 8 months previously he was put on atorvastatin 80 mg once daily. Laboratory evaluation at presentation revealed much increased levels of muscle enzymes, aminotransferases, total and conjugated bilirubin, and nitrogenous waste products, and low platelets. A diagnosis of acute renal and liver failure secondary to the long-term intensive statin therapy was made. Atorvastatin was discontinued and forced alkaline diuresis was started. After five days of oliguria and slight but persistent increase in creatinine levels dialysis was initiated, but discontinued after 4 sessions, once urine output increased. At discharge the patient’s serum creatine kinase level was in the normal range, creatinine was significantly decreased the thrombocyte count was better, aminotransferase were much lower but not completely normalized, but the bilirubin remained at the same level. The patient was discharged and instructed to avoid any potentially nephrotoxic and hepatotoxic drugs until next outpatient evaluation.

Conclusions: Our case report is meant to raise concerns about prescribing high dose statins. Unfortunately the prescribing cardiologists may be insufficiently aware of the potential for severe adverse effects as these come to the attention of clinicians from different specialities, especially nephrologists.

Background: Cyclophosphamide (CP) and Ifosfamide (IF) are widely used cytotoxic agents. Both CP and IF exert some characteristic adverse drug reactions including kidney damage taking various clinical forms, depending on the applied dose or administration route. The aim of our study was to estimate kidney function using selected, classical biochemical parameters as well as analyzing the urinary concentration and excretion of a modern “kidney troponin” - neutrophil gelatinase-associated lipocalin-1 (NGAL-1) in rats after administration of a single CP or IF dose.

Methods: 30 rats were divided into three groups (n=10 each; half males and females): group 1 - control (rats receiving i.p. saline solution); groups 2 and 3 – rats intraperitoneally treated with a single CP or IF dose of 150 mg/kg b.w., respectively. Following saline/CP/IF administration, animals were housed in single metabolic cages, to assess 24-hour diuresis and to obtain urinary samples for further laboratory assays. Finally, blood samples were collected and rats were sacrificed to perform autopsy with cystectomy and nephrectomy with subsequent histopathological analysis. Standard parameters of kidney function were assayed either in blood or in urine with an additional assessment of the urine NGAL-1 level.

Results: Single administration of both CP and IF resulted in decreased pH of urine and proteinuria accompanied by an increased 24-hour urinary NGAL-1 excretion. Moreover, CP-treated rats demonstrated polyuria. Concentrations and 24-hour excretion of most classical, low-weight parameters were not different in both CP- and IF-treated rats compared to values observed in control animals.

The histopathological analysis in CP/IF treated animals revealed presence of cystic inflammatory lesions and a normal kidney structure, with the exception of a mild to moderate congestive hyperemia.

Conclusion: A single administration of CP and IF caused a functional kidney tubulopathy in study rats manifested by marked proteinuria with increased 24-hour NGAL-1 urinary excretion.

In Type 2 diabetes, C-Reactive Protein (CRP) as an inflammatory marker may be elevated. The glycoprotein Chondrex or YKL-40 is over expressed in many inflammatory conditions. The aim is to study serum hsCRP and YKL-40 in Type 2 diabetic patients in relation to cardiovascular complications.

Methods: Eighty subjects were divided into 3 groups: GROUP 1:16 apparently healthy controls, GROUP 2:16 patients suffering from Type 2 DM without cardiovascular complications and GROUP 3: 48 patients suffering from Type 2 DM with cardiovascular complications. Subjects with acute or chronic inflammation, autoimmune disease or malignancy were excluded. Electrocardiography, Carotid Intima Thikness, Fundus Examination, laboratory investigations: (Complete urine analysis, urinary albumin, Creatinine and calculation of urinary albumin to creatinine ratio, fasting and postprandial glucose, glycated hemoglobin, Creatinine and uric acid, lipid profile, glomerular filtration rate, CRP and YKL-40) were done to all subjects.

Results: High sensitivity CRP levels were significantly elevated in the diabetic group with cardiovascular complications when compared to the diabetic group without cardiovascular complications (p=0.024). YKL-40 was significantly higher in patients with type 2 diabetes mellitus than controls (p=0.017) and cardiovascular complications (p<0.001) contributed to its greater elevation.YKL-40 was positively correlated with triglycerides, systolic and mean blood pressure in the group of diabetic patients without cardiovascular complications and with duration of diabetes and urinary albumin to creatinine ratio in the group with cardiovascular complications. By drawing receiver operating characteristic (ROC) curve between diabetic patients without and with cardiovascular complications the AUC for hsCRP was (0.676, p=0.036) and for YKL-40 was (0.743, p=0.004). By studying the diagnostic performance, YKL-40 had a better specificity and positive predictive value than hsCRP.

Conclusion: YKL-40 has a better specificity and positive predictive value than hsCRP in discriminating between diabetic patients with cardiovascular complications from those without cardiovascular complications.

Relationship between Angiotensin II Type 1 Receptor (AT1R) A1166C gene polymorphism and renal scarring risk is still controversial. This meta-analysis was performed to evaluate the association of AT1R A1166C gene polymorphism and renal scarring risk susceptibility. A predefined literature search and selection of eligible relevant studies were performed to collect data from electronic databases of PubMed, Embase and Cochrane Library. Three literatures were identified and included for the analysis of the relationship between AT1R A1166C gene polymorphism and renal scarring risk. We found that AT1R A1166C gene polymorphism was not associated with renal scarring susceptibility using the comparison of patients with scarring vs patients without scarring (C: OR=1.33, 95%CI: 0.83-2.13, P=0.23; CC: OR=1.71, 95%CI: 0.22-13.56, P=0.61; AA: OR=0.69, 95%CI: 0.39-1.21, P=0.20). Furthermore, AT1R A1166C gene polymorphism was also not associated with renal scarring risk using the comparison of patients with scarring vs healthy control. In conclusion, AT1R A1166C gene polymorphism was not associated with renal scarring risk susceptibility. However, more studies should be performed in the future.