地诺单抗治疗晚期慢性肾脏病伴严重低钙血症和低镁血症：病例报告及文献综述
Severe Hypocalcemia and Hypomagnesemia with Denosumab in Advanced Chronic Kidney Disease: Case Report and Literature Review.
作者信息
Marlow Christina F, Sharma Shailendra, Babar Faizan, Lin Jianqing
机构信息
Department of Internal Medicine, George Washington University School of Medicine, USA.
Division of Kidney Diseases and Hypertension, George Washington University School of Medicine, USA.
出版信息
Case Rep Oncol Med. 2018 Oct 14;2018:2059364. doi: 10.1155/2018/2059364. eCollection 2018.
BACKGROUND
Denosumab has become the preferred agent over zolendronic acid to help prevent skeletal-related events in patients with metastatic bone disease and multiple myeloma because it is approved for use in those with kidney dysfunction. However, denosumab has been linked to cases of hypocalcemia, particularly in those with advanced kidney disease.
CASE PRESENTATION
We present the case of a patient with metastatic prostate cancer and chronic kidney disease due to obstructive nephropathy who developed severe hypocalcemia and hypomagnesemia after denosumab injection, which required intensive care unit admission, aggressive calcium supplementation, and hemodialysis assistance. We reviewed the evidence behind the safety profile of denosumab in chronic kidney disease, and we also looked at additional factors that may precipitate severe hypocalcemia with denosumab in advanced kidney disease.
CONCLUSION
We believe that denosumab should be avoided in advanced chronic kidney disease due to the potential life-threatening, severe hypocalcemia that has been observed.
背景
地诺单抗已成为比唑来膦酸更受青睐的药物，用于帮助预防转移性骨病和多发性骨髓瘤患者的骨相关事件，因为它被批准用于肾功能不全患者。然而，地诺单抗与低钙血症病例有关，尤其是在患有晚期肾病的患者中。
病例介绍
我们报告了一例因梗阻性肾病导致转移性前列腺癌和慢性肾病的患者，该患者在注射地诺单抗后出现严重低钙血症和低镁血症，需要入住重症监护病房、积极补钙并接受血液透析辅助治疗。我们回顾了地诺单抗在慢性肾病中安全性的相关证据，还研究了在晚期肾病中可能促使地诺单抗引发严重低钙血症的其他因素。
结论
我们认为，鉴于已观察到地诺单抗可能导致危及生命的严重低钙血症，晚期慢性肾病患者应避免使用地诺单抗。
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