A MULTI-CASE REPORT OF ACUTE RENAL FAILURE IN PATIENTS TREATED WITH AGGRENOX®

Main Article Content

Kerry Joy
Sacha Dubois
Carrie Gibbons
John Hargadon
Michel Bédard

Keywords

Clinical pharmacology, Aggrenox®, Dipyridamole, acetylsalicylic acid, acute renal failure

Abstract

Background


Aggrenox® is used in the secondary prevention of stroke. Acute renal failure, potentially associated with Aggrenox®, has been observed in several patients.


 


Objective


The objective of this study was to determine if Aggrenox® was associated with acute renal failure and to determine whether it was acetylsalicylic acid, dipyridamole or the combination that led to decline in renal function.


 


Methods


A case series of three patients suffering severe nausea, vomiting, diarrhea, renal dysfunction and clinical decline during Aggrenox® therapy was examined. Serum creatinine and Blood Urea Nitrogen (BUN) were measured to evaluate renal function.


 


Results


Analysis of this patient group revealed that Patient 1 experienced nausea, emesis, anorexia, diarrhea and significant clinical decline during treatment with Aggrenox®. Patients 2 and 3 also presented with complaints of nausea and emesis. Lab measurements along with clinical symptoms indicated that all three patients experienced acute renal failure, having increases in serum creatinine of 186%, 144% and 249%, respectively. Symptoms and lab work returned to baseline following discontinuation of Aggrenox®.


 


Conclusion


It is biologically plausible that Aggrenox® may contribute to renal dysfunction in patients under certain pathophysiological circumstances.

Abstract 158 | PDF Downloads 221

References

1. Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143:1-13.
2. Matura LA, Mengo PF. Guidelines for Diagnosis and Management of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction. The Internet Journal of Advanced Nursing Practice. 2003;6.
3. Lopez Farre, AJ. Mechanism of action of acetylsalicylic acid (ASA). Available at: http://www.viva.vita.bayerhealthcare.com/index. php?id=36&tx_ttnews%5Btt_news%5D=10042&cHash=b1a67cfec2. [Accessed December 15, 2008].
4. American Society of Health-System Pharmacists. AHFS Drug Information. Bethesda, MD: American Society of Health- System Pharmacists, Inc., 2008.
5. Bendayan R. Interaction of dipyridamole, a nucleoside transport inhibitor, with the renal transport of organic cations by LLCPK1 cells. Can J Physiol Pharmacol. 1997;75:52-56. 6.
6. Sano N, Sato S, Hashimoto K. Differences among dipyridamole, carbochromen and lidoflazine in responses of the coronary and the renal arteries. Jpn J Pharmacol. 1972;22:857- 865.
7. Spielman WS, Arend LJ. Adenosine receptors and signaling in the kidney. Hypertens. 1991;17:117-130.
8. Hall JE, Granger JP. Adenosine alters glomerular filtration control by angiotensin II. Am J Physiol. 1986;250:F917-F923.
9. Spielman WS, Osswald H. Blockade of postocclusive renal vasoconstriction by an angiotensin II antagonists: evidence for an angiotensin-adenosine interaction. Am J Physiol. 1979;237:F463-F467.
10. Arend LJ, Thompson CI, Spielman WS. Dipyridamole decreases glomerular filtration in the sodium-depleted dog. Evidence for mediation by intrarenal adenosine. Circ Res. 1985;56:242-251.
11. Llach J, Gines P, Arroyo V, et al. Effect of dipyridamole on kidney function in cirrhosis. Hepatology. 1993;17:59-64.
12. Latham TB, Prato FS, Wisenberg G, Reese L. Effects of dipyridamole infusion on human renal function observed using technetium-99m-DTPA. J Nucl Med. 1992;33:355-358.
13. Katholi RE, Taylor GJ, McCann WP, et al. Nephrotoxicity from contrast media: attenuation with theophylline. Radiology. 1995;195:17-22.
14. Arend LJ, Bakris GL, Burnett JC, Jr., Megerian C, Spielman WS. Role for intrarenal adenosine in the renal hemodynamic response to contrast media. J Lab Clin Med. 1987;110:406-411.
15. Deray G, Martinez F, Cacoub P, Baumelou B, Baumelou A, Jacobs C. A role for adenosine calcium and ischemia in radiocontrast-induced intrarenal vasoconstriction. Am J Nephrol. 1990;10: 316-322.
16. Seideman P, Sollevi A, Fredholm BB. Additive renal effects of indomethacin and dipyridamole in man. Br J Clin Pharmacol. 1987;23:323-330.
17. Al Hwiesh A. Aggrenox-associated acute interstitial nephritis. Saudi J Kidney Dis Transpl. 2006;17:50-53.
18. Shaver MJ, Shah SV. Nephrology: Acute Renal Failure. In: Federman DD, Nabel EG, eds. ACP Medicine. New York, NY: BC Decker Inc., 2009.
19. Feinfeld DA, Anthony VL. Renal Principles. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS, eds. Goldfrank's Toxicologic Emergencies. New York, NY: The McGraw-Hill Companies, Inc., 2006: 427-441.
20. Amend WJC, Vincenti FG. Oliguria: Acute Renal Failure. In: Tanagho EA, McAninch JW, eds. Smith's General Urology. New York, NY: Lange Medical Books/McGraw-Hill, Medical Publishing Division, 2008: 531-534.
21. Singri N, Ahya SN, Levin ML. Acute renal failure. J Am Med Assoc. 2003;289:747-751.
22. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204-R212.
23. Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. 2005;365:417-430.
24. Kumar S, Stein JH. Acute Renal Failure. In: Stein JH, ed. Internal Medicine. Mosby, Inc., 1998: 768-775.
25. Ross JE. Diseases of the Kidney. In: Taylor RB, ed. Family Medicine: Principles and Practice. New York, NY: Springer-Verlag New York, Inc., 2003: 833-840.
26. Tello R, Hartnell GG, Hill T, Volpe J, Finn JP, Cohen M. MR perfusion imaging of the kidney pre- and post-dipyridamole stress. J Magn Reson Imaging. 1996;6:460-464.
27. Redlak M, Szczepanska-Konkel M, Stepinski J, Angielski S. Effects of dipyridamole and furosemide on renal function during adenine dinucleotide infusion in rats. Acta Physiol Pol. 1986;37:1-7.