Simvastatin-Induced Myoglobinuric Acute Kidney Injury Following Ciclosporin Treatment for Alopecia Universalis

In 2010, a case report detailed a 45-year-old woman with alopecia universalis who developed severe myoglobinuric acute kidney injury after being treated with ciclosporin (CSA) and concomitantly using simvastatin. The patient had been on CSA for a year before starting simvastatin (20 mg/day). Upon hospital admission, her serum creatinine level was 13.8 mg/dL, and she was oligo-anuric. Both CSA and simvastatin were discontinued, and she underwent eight daily hemodialysis sessions. After one month, her serum creatinine level decreased to 3.5 mg/dL, and after two months, it stabilized at 1.4 mg/dL with a creatinine clearance of 43.2 ml/min. The report concluded that physicians should be cautious of the potential risks when combining CSA and statins, and patients should be monitored for muscle symptoms, serum creatinine, muscle enzyme levels, blood CSA levels, and liver function tests. The case also highlighted the increased risk of statin-induced rhabdomyolysis when used with drugs like CSA, which are both metabolized by the cytochrome 3A4 (CYP 3A4) enzyme system.