Renal tubular acidosis secondary to capecitabine, oxaliplatin, and cetuximab treatment in a patient with metastatic colon carcinoma: a case report and review of the literature

Sonnenblick, Amir; Meirovitz, Amichay

doi:10.1007/s10147-010-0050-0

Cited by 7 publications

(5 citation statements)

References 11 publications

(18 reference statements)

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“…The EGFRs are mainly expressed in distal tubules and collecting ducts and participate in magnesium ion reabsorption. It has been reported that EGFR inhibitors can cause hypomagnesemia [7], concurrent hypokalemia [8], and a rare case of renal tubular acidosis reported in Cetuximab [9]. The finding of the normal magnesium did not support tubular injury induced by an EGFR inhibitor.…”

Section: Discussionmentioning

confidence: 85%

Severe Hypophosphatemia as the Initial Presentation of Renal Fanconi’s Syndrome and Distal Renal Tubular Acidosis Related to Zoledronic Acid: A Case Report and Literature Review

et al. 2022

Kidney Blood Press Res

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Introduction: Zoledronic acid (ZA) is a widely used bisphosphonate compound for the prevention of skeletal metastasis-associated osteolysis and treatment of post-menopause osteoporosis. Acute kidney injury is one of the commonly described renal complications. Electrolytes disorder has also been reported relevant to ZA exposure and nephrotoxicity. Syndrome of persistent hypophosphatemia, hypokalemia and metabolic acidosis is regarded as the initial signs of acute kidney injury. Case presentation: We reported a 64-year-old female with bone metastasis from lung adenocarcinoma who received a 5-year history of 4-week cycle ZA infusion. She initially presented symptomatic severe hypophosphatemia and was finally identified with ZA-induced generalized tubular dysfunction as Fanconi’s syndrome and distal renal tubular acidosis. Renal pathological findings revealed toxic renal tubular necrosis. The ZA infusion was thus extended to an 8-week cycle with oral phosphate supplementation and alfacalcidol. Although periodic changes pre- and post-ZA infusion existed yet, hypophosphatemia was effectively improved and the rapid decline of eGFR was partially delayed. We reviewed the literature and mainly summarized the characteristics of bisphosphonates-associated hypophosphatemia. Moderate hypophosphatemia was more frequently mentioned in contrast to severe cases being predisposed to be reported. And progressive hypophosphatemia serves as an early sign of kidney injury. Conclusion: Progressive electrolyte disorders and CKD were the long-term renal outcome of the current patient. We would like to arouse more attention to electrolytes imbalance related to early ZA-induced kidney injury and emphasize the significance of close monitoring.

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Section: Discussionmentioning

confidence: 85%

Severe Hypophosphatemia as the Initial Presentation of Renal Fanconi’s Syndrome and Distal Renal Tubular Acidosis Related to Zoledronic Acid: A Case Report and Literature Review

et al. 2022

Kidney Blood Press Res

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“…A previous study [ 15 ] reported a hypokalemia rate of 20.4% after capecitabine treatment, and diarrhea was the leading cause. In another case, Sonnenblick et al [ 16 ] found that distal renal tubular acidosis induced by capecitabine may be the underlying cause for hypokalemia. Our patient showed no gastrointestinal side effects, and her acid–base balance was good as well.…”

Section: Discussionmentioning

confidence: 99%

Capecitabine-induced severe diabetes and hypokalemia: a case report

2022

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Background Capecitabine is widely used in chemotherapy for breast, colorectal, and gastric cancers. The frequent adverse reactions of capecitabine mainly include gastrointestinal side effects, anemia, and cardiovascular toxicity. Here, we report a rare case of severe hyperglycemia and hypokalemia during long-term treatment with capecitabine. Case presentation A 48-year-old Chinese female was hospitalized with the complaint of breathlessness and weakness after activity, for 1 month. Her past history is significant for a diagnosis of right-sided breast cancer 7 years ago. She underwent right mastectomy, following which capecitabine was started 1.5 years prior to the current admission as part of her primary treatment at the discovery of systemic osseous metastasis. Her fasting plasma glucose and hemoglobin A1c levels were quite normal 7 months ago but increased to 15.3 mmol/L and 11.2%, respectively, at the present admission. Her serum potassium level was as low as 2.5 mmol/L. Plasma autoantibodies related to islets and insulin were all negative. Capecitabine was discontinued, and an insulin pump and potassium supplement were given after admission. Her blood sugar and potassium levels returned to their normal ranges soon. Self-injection of insulin was withdrawn completely at 2 months after discharge, and no oral hypoglycemic agents were added. Her plasma glucose and electrolyte levels were at normal levels at her 1-year follow-up. Conclusion Glucose intolerance and hypokalemia may be rare but serious adverse effects during long-term chemotherapy with capecitabine.

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“…19 In recent years, there have been multiple reports of different forms of renal toxicity related to oxaliplatin in combination with other agents. 3-17 Renal pathologies associated with oxaliplatin use include acute tubular necrosis (ATN), 4,6,11 renal tubular acidosis (RTA), 9,12,13 IMHA, 3,5,8,10,14,15 and HUS/TTP (Table 2). 7,16…”

Section: Discussionmentioning

confidence: 99%

“…2 Unlike other platinum derivatives, oxaliplatin has acceptable nephrotoxicity 1 ; however, recent case reports suggest various forms of renal toxicity related to oxaliplatin in combination with other agents. 3-17…”

Section: Introductionmentioning

confidence: 99%