Department of Medical Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain.
J Med Case Rep. 2024 Nov 17;18(1):546. doi: 10.1186/s13256-024-04862-z.
Platinum-based antineoplastic drugs are widely used in the treatment of solid tumors. Carboplatin is a safe and efficacious adjuvant treatment for stage I seminoma following a risk-adapted treatment strategy. It consists in the administration of one or two courses for patients with one or both of rete testis involvement or tumor size more than 4 cm. Carboplatin is used with the purpose of minimizing nephrotoxicity and ototoxicity caused by cisplatin while achieving excellent results. We present a case of carboplatin-induced hematuria that led to an acute kidney injury as a rare complication.
A 48 year-old Caucasian man with no medical history and no history of renal disease presented with a painless testicular mass. He underwent an orchiectomy for stage I testicular seminoma and received one course of adjuvant carboplatin (area under the curve of 7); 2 days later, he developed frank hematuria associated with back pain. The physical examination revealed mild suprapubic tenderness and Goldflam's sign was positive bilaterally. Blood tests did not reveal anemia, his platelet count was normal, and creatinine levels were in range. Due to persisting hematuria requiring continuous bladder irrigation, he was hospitalized to monitor renal function and was initially managed conservatively with intravenous analgesics and adequate hydration. The following day, he developed an acute kidney injury (serum creatinine 1.90 mg/dL, glomerular filtration rate 41 mL/min/m). Transurethral cystoscopy showed a blood clot on the left urinary meatus, which was irrigated and removed, revealing a clear ureteral jet. With no further measures, creatinine started declining and back pain improved. His acute kidney injury resolved in the following 72 hours. Computed tomography urogram showed a left ureteral ectasia with an enhanced urothelium within the upper and middle ureter, suggesting ureteral obstruction. The patient improved completely and was discharged successfully. On further follow-up 2 months later, a computed tomography urogram showed a complete resolution of obstructive changes.
Hematuria and acute kidney injury are rare but clinically relevant adverse events associated with the administration of carboplatin, regardless of the administered and accumulated dose. It is crucial to recognize this event and start adequate hydration promptly to prevent further kidney damage and the need for more aggressive measures, such as ureteral stenting or percutaneous nephrostomy.
铂类抗肿瘤药物广泛用于治疗实体瘤。卡铂是一种安全有效的辅助治疗方法，适用于风险适应治疗策略后的 I 期精原细胞瘤。对于累及一个或两个睾丸网或肿瘤直径大于 4cm 的患者，给予一至两个疗程的卡铂治疗。使用卡铂的目的是在达到良好效果的同时，将顺铂引起的肾毒性和耳毒性降至最低。我们报告了一例卡铂引起的血尿导致急性肾损伤的罕见并发症。
一名 48 岁白人男性，无既往病史和肾脏疾病史，表现为无痛性睾丸肿块。他接受了 I 期睾丸精原细胞瘤根治性切除术，并接受了一个疗程的辅助卡铂（曲线下面积 7）治疗；两天后，他出现了伴有背痛的肉眼血尿。体格检查发现轻度耻骨上压痛，双侧 Goldflam 征阳性。血液检查未发现贫血，血小板计数正常，肌酐水平正常。由于持续血尿需要持续膀胱冲洗，他被收入院监测肾功能，并接受静脉内镇痛和充分补液的保守治疗。第二天，他出现急性肾损伤（血清肌酐 1.90mg/dL，肾小球滤过率 41mL/min/m）。经尿道膀胱镜检查显示左侧尿道口有血凝块，冲洗并取出后，发现输尿管喷射清晰。未采取进一步措施，肌酐开始下降，背痛改善。他的急性肾损伤在接下来的 72 小时内得到缓解。尿路 CT 显示左侧输尿管扩张，输尿管中上段强化尿路上皮，提示输尿管梗阻。患者完全康复并成功出院。进一步随访 2 个月后，尿路 CT 显示梗阻性改变完全消退。
血尿和急性肾损伤是卡铂治疗相关的罕见但具有临床意义的不良反应，无论给药剂量和累积剂量如何。重要的是要认识到这一事件，并迅速开始充分补液，以防止进一步的肾损伤和需要更积极的措施，如输尿管支架或经皮肾造口术。
