Acute Renal Failure & ezitimibe

On Jul 12 we discussed an interesting case of renal failure in a patient with recurrent UTIs and recent lower GI bleeding.

Key learning points included:

1. Acute renal failure can be divided into prerenal (decreased renal blood flow), renal (intrinsic parenchymal damage), and postrenal (urine obstruction) causes. Of these, pre-renal causes are the most common. Key features on history include a detailed medication history, including any recent changes in potentially nephrotoxic or diuretic medications, as well as history of over-the-counter medications (ie NSAIDS) and recent Abx use (several can cause interstitial nephritis). We also need to remember to ask questions around the CAUSES of ARF and the COMPLICATIONS of ARF. Here's a review article from BMJ. Figure 1 gives a good list of investigations to order, but remember that this needs to be tailored based on history, physical, available investigations, and clinical suspicion. Remember to consult our nephro colleagues if the ARF is not improving despite your treatments, or if cause appears unclear.

2. We also discussed the evidence for ezitimibe. No benefit in progression of Aostenosis (SEAS study), and no benefit in carotid intima thickness - I am not sure to be honest how clinically relevant that knowledge is! We do know that ezitimibe has not been shown to have a mortality benefit for primary or secondary prevention.