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Febuxostat-associated rhabdomyolysis in chronic renal failure

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Clinical record

A 68-year-old man of European descent presented to our emergency department with rhabdomyolysis and acute-on-chronic kidney disease. He had a history of stage 3 chronic kidney disease (CKD3) — based on 17 tests in the year before this admission, his estimated glomerular filtration rate (eGFR) was 35 ± 7 mL/min/1.73m2 (CKD3: eGFR = 30–59 mL/min/1.73m2), his serum creatinine concentration was 179 ± 42 µmol/L (reference interval [RI], 60–120 µmol/L) — and of polyarticular tophaceous gout, type 1 diabetes mellitus, hypertension, ischaemic heart disease (coronary artery bypass grafting in 1998) and peripheral vascular disease.

His gout, diagnosed 13 years before this presentation, had been treated with allopurinol and then colchicine. Both, however, caused anaphylactic reactions. He had had multiple short courses of prednisolone to treat acute attacks on a background of naproxen. A month before this presentation, naproxen was withdrawn and treatment with a new hypouricaemic drug, febuxostat(40 mg daily) initiated. This drug was obtained through the Special Access Scheme of the Therapeutic Goods Administration. Two doses of febuxostat were withheld 12 days before this admission when he was admitted to hospital for 8 days with Haemophilus influenzae