Creatinine [BTG]

Statins are the primary class of medication used to lower serum cholesterol concentration for both primary and secondary prevention of cardiovascular disease. Muscle pain is a frequent adverse effect of statins. Severe myonecrosis leading to clinical rhabdomyolysis is rare. We encountered a 63-year-old male with a medical history of hypertension, type 2 diabetes mellitus, and coronary artery disease with angioplasty in 2008 and 2020. He was started on rosuvastatin 40 mg (0-0-2) along with dual anti-platelets post angioplasty and was discharged home. He traveled back to his hometown and noticed progressive symmetric muscle weakness with decreased urine output. After visiting another hospital he presented to us with severe proximal muscle weakness and acute renal failure. Laboratory investigations were initiated which demonstrated clinically significant derangement in serum creatinine phosphokinase, serum creatinine, urine myoglobin along with deranged liver enzymes. He was subjected to nerve conduction studies for his muscle weakness which was normal and electromyography showed abnormal spontaneous muscle activity in all examined muscles (fibrillations, positive sharp waves, and pseudomyotonic discharges) suggestive of an irritable myopathy. The medication was stopped and he was treated with eight cycles of hemodialysis until his muscle weakness and laboratory parameters improved. He was then discharged with some improvement in muscle weakness. On two week follow-up, the patient showed partial improvement after discontinuation of all lipid-lowering medication.

The aim of this study was to investigate the inhibitory effect of non-precursors amino acids (histidine, leucine, proline and methionine) which have advantages of safety, inexpensiveness and high standardization on the formation of beta-carbolines in roast beef patties and glucose/creatine/creatinine/tryptophan model system, and the possible pathway of inhibition by monitoring the scavenging of free radicals by electron paramagnetic resonance (EPR) spectroscopy and the consumption of tryptophan by HPLC in a glucose/tryptophan model system. Almost all amino acids can inhibit beta-carbolines in roast beef patties (up to 80.62%) and model system (up to 67.01%). Histidine showed an excellent alkyl radical scavenging ability (up to 82.59%) and a highly competitive inhibition ability (up to 65.60%) against beta-carbolines generation. The corresponding abilities of leucine and methionine were less remarkable. Proline could only suppress beta-carbolines through competitive inhibition. The results could shed light on the reduction of beta-carbolines during meat processing.