Acute Kidney Injury and Creatine Kinase Elevation After Beginning Treatment with Levetiracetam

Levetiracetam (LEV) is one of the most common anti-epileptic drugs available. In general, it is tolerated relatively well; the majority of adverse effects are moderate and normally occur during the initial titration. We present a patient who developed two moderately serious adverse effects after an initial LEV dose: a 28-year-old male was admitted to intensive care unit after suffering two generalised seizures, and was given 1000 mg of LEV. Twenty-four hours after admittance, the laboratory tests showed a serum creatinine of 2.84 mg/dL and creatine kinase (CK) of 421 U/L (normal, 0–171 U/L). At all times the diuresis was normal, with a maximum value of creatinine of 4.67 mg/dL 48 hours following admittance, and the CK values ranged between 421–681 U/L with proteinuria of 840 mg/day. On the seventh day, blood tests showed a CK of 1,559 U/L and a creatinine of 1.55 mg/dL. LEV was progressively substituted for lacosamide, after which creatinine, CK and albumin excretion rate were normalised. Thus, CK and renal function during treatment with LEV should be monitored, and acute kidney injury due to LEV should be considered in the differential diagnosis for any unexplained acute renal failure.