Matsumura Eiri, Oshiro Yoshinori, Miyagi Ryota, Kimura Ryu, Ashimine Satoshi, Machida Noriko, Miyazato Minoru, Saito Seiichi
The Department of Urology, Graduate School of Medicine, University of the Ryukyus.
Hinyokika Kiyo. 2012 Aug;58(8):425-9.
Renal impairment with a decreased glomerular filtration rate is a classical nephrotoxicity associated with cisplatin (CDDP). Renal salt wasting syndrome (RSWS), which is characterized by water and salt wasting, is a rare nephrotoxicity associated with CDDP. This syndrome shares many similarities with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thus, it is important to differentiate between RSWS and SIADH because the treatment of one affects the pathogenesis of the other. Here, we report a case of RSWS after chemotherapy with CDDP. A 72-year-old man with bladder urothelial carcinoma (cT2N0M0) was admitted to our hospital for the first cycle of neoadjuvant chemotherapy with CDDP and gemcitabine. He was administered intravenous fluids on day 2 before chemotherapy. Five days later, he developed nausea, dysorexia, delirium, hyponatremia (serum sodium level 115 mEq/l), and renal dysfunction. Thus, we administered a normal saline infusion. Over the next 6 days, his serum sodium level increased to 137 mEq/l, and we stopped normal saline infusion. Three days after discontinuation of saline infusion, his serum sodium level again decreased to 128 mEq/l, and the next day, his systolic blood pressure dropped gradually between 70 and 80 mmHg. Therefore, we resumed the normal saline infusion, and after 3 days, his serum sodium level increased to 135 mEq/l and systolic blood pressure ranged between 110 and 130 mmHg. On the basis of dehydration and high urinary sodium excretion at the onset of chemotherapy, we diagnosed this clinical condition as RSWS. We abandoned neo-adjuvant chemotherapy, and performed total cystectomy and ileal conduit. Since 4 months after surgery, he has been free from recurrence and metastasis.
肾小球滤过率降低所致的肾功能损害是顺铂（CDDP）相关的典型肾毒性。肾盐消耗综合征（RSWS）以水盐消耗为特征，是一种与CDDP相关的罕见肾毒性。该综合征与抗利尿激素分泌不当综合征（SIADH）有许多相似之处。因此，区分RSWS和SIADH很重要，因为其中一种疾病的治疗会影响另一种疾病的发病机制。在此，我们报告1例CDDP化疗后发生RSWS的病例。一名72岁膀胱尿路上皮癌（cT2N0M0）男性因接受CDDP和吉西他滨新辅助化疗的第1周期而入住我院。化疗前第2天给他输注了静脉液体。5天后，他出现恶心、食欲减退、谵妄、低钠血症（血清钠水平115 mEq/l）和肾功能不全。因此，我们给他输注了生理盐水。在接下来的6天里，他的血清钠水平升至137 mEq/l，我们停止了生理盐水输注。停止输注生理盐水3天后，他的血清钠水平再次降至128 mEq/l，次日，他的收缩压逐渐降至70至80 mmHg之间。因此，我们恢复了生理盐水输注，3天后，他的血清钠水平升至135 mEq/l，收缩压在110至130 mmHg之间。根据化疗开始时的脱水和高尿钠排泄情况，我们将该临床情况诊断为RSWS。我们放弃了新辅助化疗，进行了全膀胱切除术和回肠膀胱术。自手术后4个月以来，他未出现复发和转移。
