Atypical Progression of Acute Renal Failure Associated with Cisplatin Chemotherapy

Cisplatin is commonly used as chemotherapy for solid tumors. Its most important side effect is nephrotoxicity, which typically produces a gradual decline in renal function. Acute tubular necrosis is the usual pathological finding, while other findings are rare. A 75-year-old man presented to the emergency department (ED) with diarrhea and hypoglycemia. He was on 5-fluorouracil (5-FU)/cisplatin chemotherapy after a radical total gastrectomy for gastric cancer. Ten days earlier, he had been discharged after the third cycle of chemotherapy with normal renal function. When he arrived in the ED, he had azotemia (creatinine = 9.2 mg/dL) necessitating emergency hemodialysis. His renal function did not recover despite hydration and conservative treatment. Since he could not receive further chemotherapy due to the renal failure, he died 4 months later due to cancer progression. A renal biopsy performed 3 months after the renal failure showed acute tubular necrosis and severe interstitial fibrosis with normal glomeruli suggesting tubulointerstitial nephritis.

비전형적 임상경과를 보인 시스플라틴 유발 급성 신부전 1예

반복되는 항암치료 후 발생하는 원인이 명확하지 않은 급성 신부전에 대하여 수일간의 보존적 치료 후에도 신부전 회복되지 않는다면 급성 간질성 신염의 가능성을 염두에 두고 조기에 신장 조직 검사를 시행하여 급성 세뇨관 괴사 이외의 다른 원인을 찾아보고 급성 간질성 신염 진단 시에는 steroid나 면역억제제 치료를 고려해야 한다. 본 증례는 cisplatin 항암치료 후 발생한 급성 간질성 신염의 가능성이 높아 문헌고찰과 함께 보고하는 바이다.