Acute renal failure as the presenting sign of disseminated intravascular coagulation in a patient with metastatic prostate cancer

Abstract

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.

A Systematic Review and Meta-Analysis of the Proportion Estimates of Disseminated Intravascular Coagulation (DIC) in Malaria

“…The meta-analysis showed that the malarial patients with acute renal failure also had a high proportion of DIC (16.7%). The association between kidney injury and DIC was explained by several studies [ 34 , 36 , 58 , 78 , 79 , 80 , 81 , 82 ]. However, its pathogenic mechanisms are not fully understood.…”

Morphological spectrum of renal pathology and its correlation to clinical features in patients with disseminated intravascular coagulation: A study involving a series of 21 autopsy cases

“…Thrombi formation within the glomerular capillaries and small arteries is present in the kidneys affected by DIC . Moreover, we recently demonstrated that focal segmental glomerulosclerosis (FSGS) occurred in a patient with prostate cancer who developed DIC . However, studies on renal pathology associated with DIC are still limited, and its characteristic histological features remain to be elucidated.…”