Carboplatin-related acute interstitial nephritis in a patient with pancreatic neuroendocrine tumor

Abstract

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.

Acute Tubulointerstitial Nephritis in Clinical Oncology: A Comprehensive Review

“…In the two cases reported by Choi et al, oxaliplatin-associated ATIN was preceded by systemic symptoms, including fever and skin rash [ 21 ]. Asai et al reported a carboplatin-associated ATIN that was also associated with fever and malaise as in the cases reported by Choi et al [ 22 ]. Thus, ATIN must be suspected in those individuals treated with platinum agents who developed renal impairment without recovery despite drug discontinuation, especially if systemic symptoms are present.…”

Acute kidney failure and acute pancreatitis was caused after neoadjuvant therapy for a patient with Breast Cancer：a case report

“…Firstly, no matter in clinical research or in the researches carried out in the laboratory, there are many reports about the impairment of kidney function even acute renal failure caused by carboplatin[ [4][5][6][7][8], which is rare in adverse reactions of the remaining three drugs. Secondly, in the process of recording the medical history, the patient denied the history of diabete, but blood glucose monitoring shows the patient may have diabete(Table 1), which may blow up the drug damage to the kidney at a reasonable dose [9].So we consider that there is the acute kidney injury happened to this patient owing to Carboplatin.…”

“…Many experiments show that the metabolism of Carboplatin mainly depends on the kidney, but how Carboplatin causes nephrotoxicity is not fully revealed, which is believed to be owing to both direct and indirect damage to the kidneys including drug absorption and transport, oxidative stress of renal proximal tubule epithelial cells, apoptosis and in ammatory response [10][11][12]. However, because of the lower nephrotoxicity than Cisplatin, acute kidney injury(AKI) caused by Carboplatin, including acute tubular necrosis can not be seen often [5].…”

Management of acute kidney injury in gastrointestinal tumor: An overview

“…However, nephrotoxicity can be considered the result of oxaliplatin in cases of repeated exposure[ 52 ]. Carboplatin is known for its low nephrotoxicity, but only case reports have confirmed that carboplatin can cause biopsy-proven AIN[ 51 , 53 , 54 ].…”

“…Carboplatin and oxaliplatin are safe for the kidneys. Studies included renal biopsies have shown that both carboplatin and oxaliplatin can cause not only ATN but also AIN[ 53 , 142 ]. Steroid treatment for AIN is controversial.…”