Dados do Trabalho

Título

Levetiracetam-induced renal failure: case report and literature review

RESUMO

Case: A 24-y-old male patient with a history of epilepsy since the age of 16, in regular use of antiepileptic drugs, was brought to our ER due to a new seizure. He had been using oxcarbazepine since the beginning of treatment. The EEG showed frequent slow wave paroxysms and slow wave peaks of 3-6 Hz. Levetiracetam had been recently added with good seizure control. Normal neurological exam. Brain MRI showed no changes. Laboratory tests showed high levels of creatinine and he progressed to acute renal failure. During hospitalization, a renal biopsy was performed, which showed acute tubular nephritis. Levetiracetam was then discontinued and valproic acid started, with progressive improvement in renal function. He was discharged from hospital after a few days and without new epileptic seizures. Discussion: Levetiracetam is a broad-spectrum anticonvulsant, being one of the most used drugs in its class. This drug has minimal pharmacokinetic interactions due to the fact that it does not bind to plasma proteins and is independent of the cytochrome p450 system. Thus, its main side effects, already reported in the literature, are dizziness, headache, asthenia, drowsiness and rarely adverse behavioral effects. However, this anticonvulsant, due to its water-soluble properties and low molecular weight, is largely eliminated by the kidneys and may, although rarely, cause repercussions in this system. There are still few cases relating the use of levetiracetam and acute renal failure, with the first case described being that of a 17-year-old girl who developed acute renal failure and interstitial nephritis ten days after starting treatment with the drug. Thus, the case described in this work is one of the few described in the literature, and only one of the three existing cases found involving a male patient. As observed by previous descriptions, the age range is variable, having affected patients from 17 to 45 years old. Final comments: The association of renal failure and levetiracetam is rare, being of fundamental importance to recognize it for a better approach. In addition, it is worth mentioning that the use of this medication, like any other, must be well evaluated, taking into account all possible risks, benefits and adverse effects.

Palavras Chave

Epilepsy. Levetiracetam. Renal failure.