Ohashi Ryuji, Hosokawa Yusuke, Kimura Go, Kondo Yukihiro, Tanaka Keiji, Tsuchiya Shinichi
Division of Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.
Int J Nephrol Renovasc Dis. 2013;6:47-51. doi: 10.2147/IJNRD.S41813. Epub 2013 Mar 6.
Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder in patients with prostate cancer. However, renal involvement in DIC associated with prostate cancer has rarely been documented. Herein, we present a case of metastatic prostate cancer presenting with acute renal failure (RF) triggered by DIC. An 80 year old man with metastatic prostate cancer was treated with antihormone therapy at an outpatient clinic. He was admitted to our hospital because of severe dyspnea and progressive RF. A hemorrhagic tendency was not clinically evident. Laboratory tests exhibited a significant coagulation disorder, suggestive of DIC. Despite treatment, his RF and dyspnea worsened, and he eventually passed away. An autopsy study revealed hypertensive nephrosclerosis superimposed by fibrin rich thrombi formation involving glomerular capillaries and arterioles characteristic of DIC. Additionally, focal segmental glomerulosclerosis was identified, which was presumably secondary to the glomerular endothelial and/or podocyte injury augmented by DIC. Those findings showed that glomerular injury, which was induced and subsequently exacerbated by DIC associated with prostate cancer, highly contributed to the progression of RF in our case. A differential diagnosis of DIC should be considered when a patient with prostate cancer presents with renal dysfunction.
弥散性血管内凝血（DIC）是前列腺癌患者中最常见的凝血障碍。然而，前列腺癌相关DIC累及肾脏的情况鲜有文献记载。在此，我们报告一例转移性前列腺癌患者，其因DIC引发急性肾衰竭（RF）。一名80岁转移性前列腺癌男性患者在门诊接受抗激素治疗。他因严重呼吸困难和进行性RF入院。临床上未发现出血倾向。实验室检查显示明显的凝血障碍，提示DIC。尽管进行了治疗，他的RF和呼吸困难仍加重，最终死亡。尸检研究显示高血压性肾硬化叠加有富含纤维蛋白的血栓形成，累及肾小球毛细血管和小动脉，具有DIC的特征。此外，还发现了局灶节段性肾小球硬化，推测这是由于DIC加重了肾小球内皮和/或足细胞损伤所致。这些发现表明，在我们的病例中，与前列腺癌相关的DIC所诱导并随后加剧的肾小球损伤，在很大程度上导致了RF的进展。当前列腺癌患者出现肾功能不全时，应考虑DIC的鉴别诊断。
