Elevated serum creatinine levels in three patients treated with phenacemide

Area of Science:

• Nephrology
• Neurology
• Clinical Pharmacology

Background:

• Phenacemide is an anticonvulsant medication used for severe seizure disorders.
• Adolescent patients with epilepsy require effective and safe treatment options.

Observation:

• Three adolescent patients receiving phenacemide for severe seizure disorders presented with elevated serum creatinine and normal blood urea nitrogen.
• Renal function tests revealed normal urea clearance but decreased creatinine clearance.
• Inulin clearance in one patient was normal, suggesting preserved glomerular filtration.

Findings:

• Phenacemide administration led to a dose-related, reversible elevation in serum creatinine.
• The observed hypercreatininemia was not attributed to impaired glomerular filtration.
• Neutropenia necessitated phenacemide discontinuation in two patients, with subsequent normalization of creatinine levels.

Implications:

• Clinicians should monitor serum creatinine levels in adolescent patients treated with phenacemide.
• Phenacemide-induced hypercreatininemia appears to be a specific tubular effect rather than generalized renal dysfunction.
• Further research is warranted to elucidate the exact mechanism of phenacemide's effect on creatinine metabolism.