Extensive bilateral renal metastases of non-small cell lung carcinoma caused acute kidney injury resulting in end-stage
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CASE REPORT
Extensive bilateral renal metastases of non‑small cell lung carcinoma caused acute kidney injury resulting in end‑stage renal disease Ayako Miyamoto1 · Takahisa Kawakami1 · Megumi Kakinuma1 · Ryosuke Sato1 · Kazuhito Fukuoka1 · Miho Karube1,2 · Yoshinori Komagata1 · Shinya Kaname1 Received: 21 July 2020 / Accepted: 24 September 2020 © Japanese Society of Nephrology 2020
Abstract Non-small cell lung carcinoma unusually causes clinically relevant metastases in the kidney while they are usually found only in autopsy. Acute kidney injury (AKI) due to direct metastatic invasion of a solid tumor is also very rare whereas it usually happens with hematologic malignancy, including lymphoma. We report a case with these two rarities. A 54-year-old man who had a 6.7 × 6.0 cm-sized tumor in the left upper lobe of the lung in computed tomography was diagnosed as squamous cell lung carcinoma with bronchoscopy with biopsy. His renal function was normal and no proteinuria or hematuria was recognized. He underwent left upper lobectomy and the pathologic examination revealed pT4N1M0 stage IIIA disease. Four months after the surgery, a single brain metastasis in the right frontal lobe found in brain magnetic resonance imaging was treated with Gamma Knife radiosurgery. He presented with macroscopic hematuria and AKI (the serum creatinine level was 1.35 mg/dL) nine months after surgery. The cause was enormous bilateral renal metastases, maximally 8 cm-sized lesions with poor enhancement, which were found in enlarged bilateral kidneys in enhanced CT. Intrapulmonary metastatic lesions were also newly detected. Chemotherapy with pembrolizumab, an antibody against anti-programmed cell death protein 1, had little effect and his renal function continued to decline rapidly, resulting in end-stage renal disease and maintenance hemodialysis. Chemotherapy with carboplatin and paclitaxel was additionally performed. However, two months after hemodialysis induction, the patient died with pneumonia and acute respiratory distress syndrome. Keywords Acute kidney injury · Non-small cell lung carcinoma · Squamous cell lung carcinoma · Metastasis · Hemodialysis
Introduction Acute kidney injury (AKI) is an abrupt decline in renal function and a common condition that is associated with morbidity and mortality. Renal function can be completely recovered after AKI in some cases, especially when it is early detected, and the accurate diagnosis and removal of its cause is immediately achieved. Otherwise, AKI leads to irreversible renal dysfunction and chronic kidney disease (CKD). AKI occurs more frequently in patients with cancer than in * Takahisa Kawakami kawakat‑[email protected] 1
Department of Nephrology and Rheumatology, Kyorin University, 6‑20‑2, Shinkawa, Mitaka, Tokyo 181‑8611, Japan
Department of Nephrology and Rheumatology, Kosei Hospital, Suginami, Tokyo, Japan
2
the general population [1]. Unrecovered renal dysfunction causes problems in the treatment by limiting the regimen of chemotherapy and evaluation of disease progressio
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