Reactions 1486, p24 - 1 Feb 2014

SOrlistat

Chronic renal impairment: 3 case reportsThree patients developed chronic renal impairment while

receiving orlistat [routes not stated].A 54-year-old woman presented with deteriorating renal

function in May 2006. She had a BMI of 28 kg/m2, and hadreceived orlistat 120mg thrice daily from August 2005 toApril 2006. Upon presentation, she had a serum creatininelevel of 225 µmol/L, an estimated glomerular filtration rate of20 mL/min and a urinary protein level of 0.33 g/day. Ninemonths after stopping orlistat, a renal biopsy showedextensive tubular atrophy and interstitial fibrosis. At lastfollow-up, her renal function had not declined, but had notbeen reversed.

A 66-year-old woman had obesity, type 2 diabetes mellitus,essential hypertension, hypothyroidism, depression andchronic kidney disease. Upon referral in January 2011, she hada BMI of 37 kg/m2. She had taken orlistat intermittently fromOctober 2006 to mid-2008, and regularly from March 2010until it was stopped in March 2011, at a dose of 120mg thricedaily [initial dosage not clearly stated]. She had a serumcreatinine level of 327 µmol/L, an estimated glomerularfiltration rate of 12 mL/min and a urinary protein creatinineratio of 38 mg/mmol. Within a week after stopping orlistat, arenal biopsy showed tubular atrophy, interstitial fibrosis andcalcium oxalate crystals in the tubules. At last follow-up, herrenal impairment had not declined, but had not been reversed.

A 68-year-old man had obesity with a BMI of 34 kg/m2,osteoarthritis and chronic kidney disease. He was referred inMarch 2011 for declining renal function. He had taken orlistat120mg thrice daily from 2007 to 2009, and from April 2010 toJanuary 2011. His serum creatinine level was 267 µmol/L, andhis urine protein creatinine ratio was 38 mg/mmol. A renaltract ultrasound showed slight renal cortical thinning. Fivemonths after stopping orlistat, a renal biopsy showedextensive tubular atrophy and interstitial fibrosis. At lastfollow-up, his renal impairment had not declined, but had notbeen reversed.

Author comment: "We describe three adult cases ofchronic renal impairment which were associated with orlistatusage."Coutinho AK, et al. Orlistat, an under-recognised cause of progressive renalimpairment. Nephrology Dialysis Transplantation 28: iv172-iv174, No. 4, Jan 2013- United Kingdom 803098848

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Reactions 1 Feb 2014 No. 14860114-9954/14/1486-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved