Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2014; 2(8): 380-384
Published online Aug 16, 2014. doi: 10.12998/wjcc.v2.i8.380
Prucalopride-associated acute tubular necrosis
Vithika Sivabalasundaram, Flavio Habal, David Cherney
Vithika Sivabalasundaram, Flavio Habal, Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, M5G 2C4, Canada
David Cherney, Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, M5G 2C4, Canada
Author contributions: Sivabalasundaram V, Habal F and Cherney D wrote and edited the manuscript; all authors have approved the final version of this manuscript.
Supported by A Kidney Foundation of Canada Scholarship and a Canadian Diabetes Association-KRESCENT Program Joint New Investigator Award and receives operating support from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada to Cherney D
Correspondence to: Flavio Habal, MD, Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, 200 Elizabeth St, 9N-977, Toronto, M5G 2C4, Canada. flavio.habal@uhn.ca
Telephone: +1-416-3405024 Fax: +1-416-5955251
Received: February 17, 2014
Revised: April 29, 2014
Accepted: June 14, 2014
Published online: August 16, 2014
Processing time: 197 Days and 23.8 Hours
Abstract

We report the first case of acute renal failure secondary to prucalopride, a novel agent for the treatment of chronic constipation. The 75 years old male patient was initiated on prucalopride after many failed treatments for constipation following a Whipple’s procedure for pancreatic cancer. Within four months of treatment his creatinine rose from 103 to 285 μmol/L (eGFR 61 decrease to 19 mL/min per 1.73 m2). He was initially treated with prednisone for presumed acute interstitial nephritis as white blood casts were seen on urine microscopy. When no improvement was detected, a core biopsy was performed and revealed interstitial fibrosis and tubular atrophy. The presence of oxalate and calcium phosphate crystals were also noted. These findings suggest acute tubular necrosis which may have been secondary to acute interstitial nephritis or hemodynamic insult. The use of prednisone may have suppressed signs of inflammation and therefore the clinical diagnosis was deemed acute interstitial nephritis causing acute tubular necrosis. There are no previous reports of prucalopride associated with acute renal failure from the literature, including previous Phase II and III trials.

Keywords: Prucalopride; Acute kidney tubular necrosis; Renal insufficiency; Constipation; Adverse drug event

Core tip: Prucalopride is a novel agent used in the treatment of chronic constipation. We report the first case of acute renal failure secondary to prucalopride four months after treatment initiation. A core renal biopsy after prednisone therapy revealed interstitial fibrosis and tubular atrophy. These findings suggested acute tubular necrosis secondary to acute interstitial nephritis. There are no previous reports of prucalopride associated with acute renal failure from the literature, including previous Phase II and III trials. This case reports highlights the need for monitoring renal function in all patients treated with prucalopride.