Agraharkar M, Nerenstone S, Palmisano J, Kaplan A A
University of Texas Medical Branch, Galveston, TX 77555-0562, USA.
Am J Kidney Dis. 1998 Nov;32(5):E5. doi: 10.1016/s0272-6386(98)70152-0.
Cisplatin is a potent tubular toxin with a high incidence of nephrotoxicity. Carboplatin is considered less nephrotoxic but can still cause tubular injury and interstitial nephritis in patients who have been previously treated with cisplatin. The affected individuals usually have nonoliguric renal failure with a urine output of more than a liter per day. We present a 57-year-old white woman with no history of renal disease who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for stage IC ovarian carcinoma. One month later, she received chemotherapy with paclitaxel (Taxol) and carboplatin. On the following day, she developed frank hematuria and flank pain associated with a diminished urine output. Intravenous pyelogram (IVP) showed bilateral hydronephrosis with a total blockage of dye flow at the level of intraureteral lucencies consistent with bilateral blood clots. Her coagulation profile and uric acid was normal. Her acute renal failure (ARF) spontaneously resolved in the following 24 hours, with a brisk diuresis presumably due to clot lysis. The follow-up IVP showed a resolution of obstructive changes. A review of the literature shows a previous case in which high doses of carboplatin were implicated as the cause of hemorrhagic cystitis, presumably by toxicity to transitional epithelium of the bladder. We believe that the current case represents carboplatin-induced damage to the transitional epithelium in the renal pelvi and ureters causing gross hematuria and blood clots, resulting in bilateral ureteral obstruction and hydronephrosis.
顺铂是一种强效的肾小管毒素，肾毒性发生率很高。卡铂被认为肾毒性较小，但在先前接受过顺铂治疗的患者中仍可导致肾小管损伤和间质性肾炎。受影响的个体通常为非少尿型肾衰竭，尿量每天超过一升。我们报告一名57岁无肾脏疾病史的白人女性，因Ic期卵巢癌接受了全腹子宫切除术和双侧输卵管卵巢切除术。一个月后，她接受了紫杉醇（泰素）和卡铂化疗。第二天，她出现明显血尿和胁腹痛，尿量减少。静脉肾盂造影（IVP）显示双侧肾盂积水，在输尿管内透亮区水平染料流动完全受阻，符合双侧血凝块表现。她的凝血指标和尿酸正常。她的急性肾衰竭（ARF）在接下来的24小时内自行缓解，出现明显利尿，推测是由于血凝块溶解。随访IVP显示梗阻性改变消失。文献回顾显示之前有一例病例，高剂量卡铂被认为是出血性膀胱炎的病因，推测是对膀胱移行上皮的毒性作用。我们认为本例代表卡铂对肾盂和输尿管移行上皮的损伤，导致大量血尿和血凝块，引起双侧输尿管梗阻和肾盂积水。
