Creatine kinase, VIII

This syndrome of myalgia, stiffness, weakness and malaise, commonly with an increase in serum enzymes, is well-recognized (SED VIII, p. 934), and in the past evidence has been advanced that it may be more common in patients with the nephrotic syndrome. In 1975, Pierides et al. pointed to the possible complications if the drug is used in chronic renal faUure. When treating 5 uraemic patients with 1 -2 g clofibrate daily, they recorded muscle weakness and tenderness as weU as a rise in serum creatine kinase. Excessive accumulation of both total and free serum chlorophenoxyisobutyric acid (C.P.I.B.), the active metabolite of clofibrate, was found in the 3 patients in whom it was sought (4 ). Their view that clofibrate should in renal failure be used very cautiously or not at all is supported by the report from Spain on a similar case where administration of 1.5 g clofibrate daily for 9 days to a patient undergoing dialysis resulted in a muscular syndrome with elevation of SCOT, SGTP, CPK, LDH and aldolase (5 ). 

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