Asai Akimasa, Katsuno Takayuki, Yamaguchi Makoto, Iwagaitsu Shiho, Nobata Hironobu, Kinashi Hiroshi, Kitamura Hiroshi, Banno Shogo, Ito Yasuhiko
Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, Aichi, 480-1195, Japan.
Department of Pathology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan.
CEN Case Rep. 2020 May;9(2):114-121. doi: 10.1007/s13730-019-00437-w. Epub 2019 Dec 13.
Carboplatin is characterized by low nephrotoxicity, including acute tubular necrosis (ATN), compared to a conventional platinum complex due to its low accumulative property in the renal tubules. Therefore, there are extremely few reports of carboplatin-induced kidney injury and only one case has been histologically examined. Herein, we describe the case of a 53-year-old man who presented with acute kidney injury (AKI) that occurred after carboplatin administration and was diagnosed with biopsy-proven acute interstitial nephritis (AIN). To our knowledge, this is the second case report of carboplatin-related AIN. The patient was diagnosed with a pancreatic neuroendocrine tumor, and chemotherapy consisting of cisplatin and irinotecan was initiated. However, 1 week later, he was admitted to our institution with fever, fatigue and an increase in C-reactive protein (CRP) level. The chemotherapy regimen was altered to carboplatin and etoposide, but high fever occurred on the first day, and CRP re-elevation and AKI became apparent 9 days later. Renal biopsy revealed prominent inflammatory cell infiltration into the interstitium, which lead to the pathological diagnosis of AIN. On immunostaining for surface markers, CD3- and CD68-positive cells were found to be predominant, and CD20-positive cells were relatively few. Although the serum creatinine level increased to 6.81 mg/dL, it decreased to 1.43 mg/dL 15 days after steroid therapy. This case demonstrated that carboplatin-related kidney injury includes not only ATN but also AIN. Appropriate pathological diagnosis including renal biopsy and indications for steroid treatment should be carefully considered.
与传统铂类复合物相比，卡铂的特点是肾毒性低，包括急性肾小管坏死（ATN），这是因为其在肾小管中的蓄积性低。因此，卡铂所致肾损伤的报道极少，仅有1例进行了组织学检查。在此，我们描述了1例53岁男性患者，其在接受卡铂治疗后出现急性肾损伤（AKI），经活检证实为急性间质性肾炎（AIN）。据我们所知，这是卡铂相关AIN的第二例病例报告。该患者被诊断为胰腺神经内分泌肿瘤，并开始接受顺铂和伊立替康组成的化疗。然而，1周后，他因发热、乏力和C反应蛋白（CRP）水平升高入住我院。化疗方案改为卡铂和依托泊苷，但第一天就出现高热，9天后CRP再次升高且AKI明显。肾活检显示间质有明显的炎性细胞浸润，从而得出AIN的病理诊断。在表面标志物免疫染色中，发现CD3和CD68阳性细胞占主导，而CD20阳性细胞相对较少。尽管血清肌酐水平升至6.81mg/dL，但在类固醇治疗15天后降至1.43mg/dL。该病例表明，卡铂相关肾损伤不仅包括ATN，还包括AIN。应仔细考虑包括肾活检在内的适当病理诊断和类固醇治疗的指征。
