Cisplatin
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Nephropathy, acute kidney failure and tumour lysis syndrome: case report A 69-year-old man developed nephropathy, acute kidney failure and tumour lysis syndrome (TLS) during treatment with cisplatin for partially papillary urothelial carcinoma of the urinary bladder. The man, who presented for an evaluation of recurrent microhaematuria, was diagnosed with partially papillary urothelial carcinoma of the urinary bladder (grade 3, high grade). A CT-scan revealed multiple enlarged retroperitoneal lymph nodes. Liver biopsy confrmed multiple hepatic metastases. His first cycle of palliative chemotherapy was carried out on an inpatient basis with cisplatin 130mg [route not stated] along with concomitant gemcitabine, with adequate antiemetic prophylaxis [specific drugs not stated]. Five days post hospital discharge, he was admitted with severe abdominal pain. He reported constipation, occuring since discharge and reduced quantity of micturition. Of note, he was afebrile and haemodynamically stable. In status, the abdomen was distended, and he had taut with diffuse tenderness with palpable hepatomegaly. Furthermore, weak bibasilar auscultation breathing sounds (crackles) were noted. Laboratory investigations showed chemically acute renal failure with hyperkalaemia and blood gasanalytic respiratory compensated metabolic acidosis. Furthermore, a significantly increased LDH was noted. Evidence of a postrenal urinary drainage obstruction was not noted sonographically. The sonographically shown bibasal pleural effusion was interpreted in the context of overhydration with acute renal insufficiency. A differential diagnosis of cisplatin-induced nephropathy or TLS was made at five days after chemotherapy in the case of acute renal failure. In addition to the pathologically changed laboratory parameters mentioned along with elevated uric acid and phosphate, and decreased ionised calcium, the diagnosis criteria for clinical TLS were met. Nephrtotoxicity, acute kidney failure and TLS were attributed to cisplatin [times to reactions onsets not clearly stated]. The man was treated with rasburicase. Thereafter, uric acid levels regressed. Continued treatment with close electrolyte controls, fluid balancing, and maintenance of acid-base balance were carried out in the ICU, where the continuous veno-venous haemofiltration was applied during the course of the indication. A normalisation of the electrolytes and acid-base balance as well as an improvement in the renal function was achieved at discharge. After a total of 15 days, an improvement in the performance status was noted. In the case of persistent renal impairment, platinum-based chemotherapy was not further continued, and a switch was made to a palliative second-line immunotherapy with pembrolizumab. However, pembrolizumab resulted in rapid tumour progression, and he died 2 months later. Autopsy was not performed [cause of death not stated]. Muller J, et al. [Unusual Cause of Acute Kidney Failure in a Patient with Metastatic Bladder Carcinoma Undergoing Palliative Chemotherapy].
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