Cinacalcet
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First report of renal haemorrhage: 2 case reports Two men, who were undergoing haemodialysis and had secondary hyperparathyroidism, developed acute renal haemorrhage during treatment with cinacalcet [routes and dosages not stated]. The 58-year-old man developed right flank and back pain while sleeping, 7 days before admission; he was admitted 14 days after cinacalcet was started. Investigations revealed anaemia and hypereosinophilia, and decreased levels of corrected calcium, inorganic phosphorus, and intact parathyroid hormone compared to before cinacalcet. CT revealed a massive right subcapsular kidney haematoma. He received blood transfusion and his anaemia improved. A drug lymphocyte stimulation test with cinacalcet was positive. Cinacalcet was withdrawn and he underwent haemodialysis with nafamostat for 14 days. He improved, and was discharged on hospital day 26 with no recurrence on follow-up. After 13 days of cinacalcet, the 36-year-old man experienced sudden onset left flank pain and developed nausea. He was admitted 4 hours later, after pentazocine and morphine failed to control his pain. Test results showed a fall in corrected calcium, inorganic phosphorus, and intact parathyroid hormone levels compared to precinacalcet. CT showed a left kidney subcapsular haematoma. The following day he developed anaemia with hypereosinophilia, and received 4 units of blood; his anaemia later resolved. A drug lymphocyte stimulation test with cinacalcet was positive. Cinacalcet was stopped and haemodialysis with nafamostat was prescribed. He improved, and was discharged on hospital day 11, and remained well at last follow-up. Author comment: "[T]here are three possibilities concerning the renal hemorrhage induced by cinacalcet. Firstly, cinacalcet itself directly induced the renal hemorrhage. Second, the change (depression) such as seen in [corrected calcium], [inorganic phosphorus], and [intact parathyroid hormone] induced by cinacalcet might cause the renal hemorrhage. Third, vasculitis induced by cinacalcet might cause the renal hemorrhage." Wada K, et al. Two cases of acute renal hemorrhage undergoing maintenance hemodialysis after concurrent administration of cinacalcet. Clinical and Experimental Nephrology 15: 783-787, No. 5, Oct 2011. Available from: URL: 803066026 http://dx.doi.org/10.1007/s10157-011-0469-2 - Japan
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Editorial comment: A search of AdisBase, Medline and Embase and the WHO ADR database did not reveal any previous case reports of renal haemorrhage associated with cinacalcet.
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Reactions 21 Jan 2012 No. 1385
