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Wan T, Yuet-Ling Tung J, Ma A, Lai-Ka Lee S, Pak-Yin Liu A, Tak-Loi Ku D, Yau PW, Ming-Kong Shing M. Carboplatin-induced renal salt-wasting syndrome in pediatric patients with intracranial germ cell tumors and concomitant diabetes insipidus. Pediatr Blood Cancer 2022; 69:e29592. [PMID: 35129877 DOI: 10.1002/pbc.29592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
We report a case series of 14 children with intracranial germ cell tumor and concomitant central diabetes insipidus, who developed hyponatremia secondary to renal salt-wasting syndrome (RSWS) following the administration of carboplatin. Clinicians prescribing platinum-based chemotherapy for this group of patients should be alert to the risk of RSWS. Regular monitoring should be performed as hyponatremia can be asymptomatic until it is severe.
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Affiliation(s)
- Tania Wan
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Joanna Yuet-Ling Tung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Alison Ma
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Samantha Lai-Ka Lee
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Anthony Pak-Yin Liu
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Dennis Tak-Loi Ku
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Ping-Wa Yau
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Matthew Ming-Kong Shing
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
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Hyponatremia in Patients with Hematologic Diseases. J Clin Med 2020; 9:jcm9113721. [PMID: 33228240 PMCID: PMC7699475 DOI: 10.3390/jcm9113721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice and is associated with increased morbidity and mortality. It is frequently encountered in hematologic patients with either benign or malignant diseases. Several underlying mechanisms, such as hypovolemia, infections, toxins, renal, endocrine, cardiac, and liver disorders, as well as the use of certain drugs appear to be involved in the development or the persistence of hyponatremia. This review describes the pathophysiology of hyponatremia and discusses thoroughly the contributing factors and mechanisms that may be encountered specifically in patients with hematologic disorders. The involvement of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion and renal salt wasting syndrome (RSWS) in the development of hyponatremia in such patients, as well as their differential diagnosis and management, are also presented. Furthermore, the distinction between true hyponatremia and pseudohyponatremia is explained. Finally, a practical algorithm for the evaluation of hyponatremia in hematologic patients, as well as the principles of hyponatremia management, are included in this review.
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Feldman DR, Glezerman I, Patil S, Van Alstine L, Bajorin DF, Fischer P, Hughes A, Sheinfeld J, Bains M, Reich L, Woo K, Giralt S, Bosl GJ, Motzer RJ. Phase I/II Trial of Paclitaxel With Ifosfamide Followed by High-Dose Paclitaxel, Ifosfamide, and Carboplatin (TI-TIC) With Autologous Stem Cell Reinfusion for Salvage Treatment of Germ Cell Tumors. Clin Genitourin Cancer 2015; 13:453-60. [PMID: 26072101 DOI: 10.1016/j.clgc.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/03/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Salvage high-dose (HD) chemotherapy with autologous stem cell transplant (ASCT), consisting of 2 to 3 sequential cycles of HD carboplatin and etoposide (CE) can achieve durable remissions in approximately half of patients with relapsed germ cell tumors. To improve on these results and based on success with paclitaxel, ifosfamide, and cisplatin (TIP) as salvage conventional-dose chemotherapy, we conducted a phase I/II trial of HD paclitaxel with ifosfamide (TI), substituting carboplatin for cisplatin to allow dose escalation. PATIENTS AND METHODS Treatment consisted of 1 to 2 cycles of TI and granulocyte colony-stimulating factor for stem cell mobilization followed by 3 cycles of HD TI with carboplatin (TIC) with ASCT every 21 to 28 days. Twenty-six patients were enrolled. For phase I, a standard 3+3 dose-escalation design was used. RESULTS With no dose-limiting toxicities observed, the maximum tolerated dose (MTD) was not reached and the highest prespecified dose level (paclitaxel 250 mg/m(2), ifosfamide 9990 mg/m(2), carboplatin area under the curve 24) was considered the MTD. In phase II, a Simon 2-stage design was used to estimate the complete response (CR) rate at the MTD. With 7 of 11 phase II patients who achieved a CR, efficacy was demonstrated. However, 3 patients developed delayed chronic kidney disease, resulting in premature trial closure. CONCLUSION TI-TIC was active in relapsed germ cell tumors but treatment-emergent chronic renal impairment, possibly from overlapping ifosfamide and carboplatin, preclude its further use. TI-CE, consisting of 2 cycles of TI with 3 cycles of HD CE remains the standard of care HD chemotherapy regimen at Memorial Sloan Kettering Cancer Center.
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Affiliation(s)
- Darren R Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
| | - Ilya Glezerman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lindsay Van Alstine
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean F Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Patricia Fischer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amanad Hughes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joel Sheinfeld
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit Bains
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lilian Reich
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Kaitlin Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - George J Bosl
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
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Altundal Y, Sajo E, Makrigiorgos GM, Berbeco RI, Ngwa W. Nanoparticle-aided Radiotherapy for Retinoblastoma and Choroidal Melanoma. IFMBE PROCEEDINGS 2015; 51:907-910. [PMID: 28003818 PMCID: PMC5166600 DOI: 10.1007/978-3-319-19387-8_221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This work investigates the dosimetric feasibility of employing gold nanoparticles (AuNPs) or carboplatin nano-particles (CNPs) to enhance radiotherapy (RT) treatment efficacy for ocular cancers: retinoblastoma (Rb) and choroidal melanoma (CM), during kV-energy internal and external beam radiotherapy. The results predict that substantial dose enhancement may be achieved by employing AuNPs or CNPs in conjunction with radiotherapy for ocular cancer using kV-energy photon beams. Brachytherapy sources yield higher dose enhancement than the external beam in kV energy range. However, the external beam has the advantage of being non-invasive.
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Affiliation(s)
| | - Erno Sajo
- University of Massachusetts Lowell, Lowell, MA, USA
| | - G Mike Makrigiorgos
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA USA
| | - Ross I Berbeco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA USA
| | - Wilfred Ngwa
- University of Massachusetts Lowell, Lowell, MA, USA; Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA USA
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Turner N, Stewart J, Barnett F, White S. Syndrome of inappropriate anti-diuretic hormone secretion secondary to carboplatin after docetaxel-carboplatin-trastuzumab combination for early stage HER-2 positive breast cancer. Asia Pac J Clin Oncol 2012; 8:e9-e11. [PMID: 22897880 DOI: 10.1111/j.1743-7563.2012.01526.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Carboplatin is a platinum analogue, widely used in the treatment of numerous cancer types including lung, genitourinary and ovarian cancers. It is also used in the adjuvant treatment of human epidermal growth factor receptor 2 positive breast cancer, where a non-anthracycline regimen is preferred. It is considered generally to be less toxic though potentially less efficacious than cisplatin, another platinum compound. Cisplatin is well recognized as causing hyponatremia, through the mechanism of renal salt wasting. Conversely, carboplatin has only rarely been associated with hyponatremia. We report here a case of severe hyponatremia occurring 6 days after adjuvant treatment with a carboplatin-containing chemotherapy regimen for early stage breast cancer. The mechanism of hyponatremia was consistent with the syndrome of inappropriate anti-diuretic hormone secretion based on biochemical and clinical findings, and response to fluid restriction. With no previously reported cases of docetaxel-associated or trastuzumab-associated hyponatremia, the causative agent was considered to be carboplatin. Additionally there was no recurrence of hyponatremia on recommencement of docetaxel and trastuzumab therapy. Hyponatremia secondary to carboplatin has been rarely reported in the literature, with only three previously reported cases. Although it is rare, oncologists should be aware of the potential for carboplatin to cause hyponatremia and the need to monitor electrolytes throughout therapy.
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Affiliation(s)
- Natalie Turner
- The Northern Hospital Austin Hospital, Melbourne, Victoria, Australia.
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Nomura M, Kamata M, Kojima H, Sawada S. Renal salt-wasting syndrome associated with docetaxel in an esophageal cancer patient. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-011-0012-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Miller RP, Tadagavadi RK, Ramesh G, Reeves WB. Mechanisms of Cisplatin nephrotoxicity. Toxins (Basel) 2010; 2:2490-518. [PMID: 22069563 PMCID: PMC3153174 DOI: 10.3390/toxins2112490] [Citation(s) in RCA: 1075] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 10/14/2010] [Accepted: 10/22/2010] [Indexed: 02/06/2023] Open
Abstract
Cisplatin is a widely used and highly effective cancer chemotherapeutic agent. One of the limiting side effects of cisplatin use is nephrotoxicity. Research over the past 10 years has uncovered many of the cellular mechanisms which underlie cisplatin-induced renal cell death. It has also become apparent that inflammation provoked by injury to renal epithelial cells serves to amplify kidney injury and dysfunction in vivo. This review summarizes recent advances in our understanding of cisplatin nephrotoxicity and discusses how these advances might lead to more effective prevention.
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Affiliation(s)
- Ronald P Miller
- Division of Nephrology, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Abstract
Chronic renal impairment in children with cancer may be caused by the malignant process itself or result from adverse effects of treatment including cytotoxic drugs, radiotherapy, surgery or supportive treatment. Although severe renal chronic disease is uncommon, occurring in only 0.8% of long-term survivors of childhood cancer, 1.9% of all cases of established renal failure are due to malignancy and 0.8% to drug nephrotoxicity. The relative risk of severe renal chronic disease (compared with siblings) is 8.1, and that of renal failure or the need for dialysis is 8.9. The cytotoxic drugs most likely to cause important chronic nephrotoxicity are ifosfamide and cisplatin, both of which are used widely in many solid tumors and may cause chronic glomerular and/or renal tubular toxicity in 30–60% of treated children. Significant renal toxicity is less frequent with other chemotherapeutic drugs, but may result from treatment with carboplatin, methotrexate and nitrosoureas. Other cytotoxic drugs occasionally cause specific patterns of glomerular or tubular toxicity in children. Partial or unilateral nephrectomy leads to hypertrophy and hyperfiltration of the remaining renal tissue, and may result in microalbuminuria, hypertension and in rare cases, chronic renal impairment. Radiotherapy to a field including renal tissue may cause late onset chronic renal damage, manifest by hematuria, proteinuria, hypertension and anemia, sometimes progressing to chronic renal failure. Chronic nephrotoxicity is also common in survivors of hemopoietic stem cell transplantation, and is often multifactorial with contributions from prior chemotherapy, total body irradiation, immunosuppressive drugs and transplant complications, such as infection or hemorrhage. Patients at risk of renal damage should be monitored regularly with a defined surveillance protocol to enable timely management. General measures often employed to prevent or reduce nephrotoxicity include the use of intravenous hydration during drug administration and avoidance of known risk factors, such as high drug doses. Although numerous potentially nephroprotective drugs have been suggested and investigated, none have yet been introduced into clinical use in children due to the lack of proven efficacy. Improved understanding of the pathogenesis of nephrotoxicity is necessary to reduce the frequency and severity of this potentially serious complication of treatment in children with cancer.
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Affiliation(s)
- Roderick Skinner
- Department of Pediatric & Adolescent Oncology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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Abstract
Cisplatin was the first platinum compound to be introduced as a chemotherapeutic agent with antineoplastic activity against a wide variety of solid tumors. Renal impairment with a decline in glomerular filtration has been the classical nephrotoxicity of cisplatin. Renal salt wasting syndrome is yet another, though it is not common. Previous studies were identified by searching the Pubmed database using the following keywords: cisplatin, cisplatin nephrotoxicity, renal salt wasting, and salt loosing nephropathy. Renal salt wasting syndrome has been described in 17 case reports since 1984. It is a rare side effect of cisplatin that manifests with polyuria, hypovolemia, and hyponatremia, and, because of similarities in clinical settings and laboratory values, it is frequently misdiagnosed as a syndrome of inappropriate antidiuretic hormone. Other causes of polyuria and hyponatremia should be excluded. Treatment aims at restoring the lost water and salt. Substituting cisplatin with carboplatin depends on individual clinical settings. Prognosis is excellent, as recovery was the rule in all the reported cases.
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Kane AJ, Sughrue ME, Rutkowski MJ, Aranda D, Mills SA, Buencamino R, Fang S, Barani IJ, Parsa AT. Posttreatment prognosis of patients with esthesioneuroblastoma. J Neurosurg 2010; 113:340-51. [PMID: 20345216 DOI: 10.3171/2010.2.jns091897] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT There is no Class I evidence to guide the appropriate management of esthesioneuroblastoma (EN). Most data currently guiding treatment come from small- or modest-sized series gathered at individual centers that have concluded that surgery with radiotherapy is the preferred treatment. In this study, the authors summarize the published literature on treatment outcomes in patients with EN. The objective was to ascertain what variables predict prognosis in these patients and to determine the relative effect of different therapies. METHODS The authors identified 205 published studies containing treatment outcomes for surgery, radiotherapy, chemotherapy, or multimodal treatment. Using Kaplan-Meier analysis, the survival of patients who received surgery was compared with that in those who received surgery and radiotherapy. Additionally, Kadish staging was compared with low- and high-grade Hyams criteria to assess for subgroup prognostic significance in survival differences. RESULTS Nine hundred fifty-six patients met the inclusion criteria, with a median follow-up time of 3 years. Kaplan-Meier analysis demonstrated no difference in survival between patients who underwent surgery alone and those who underwent surgery plus radiotherapy at 5 years (78 vs 75%) or 10 years (67 vs 61%, respectively) (p = 0.3). Univariate analysis demonstrated worse survival in cases involving Kadish Grade C tumors, Hyams Grade 3 and 4 tumors, and in patients older than 65 years of age. Multivariate analysis demonstrated that Hyams Grade 3 and 4 lesions carried significant risk (proportional hazard = 4.83, p < 0.001) with 5- and 10-year survival of 47 and 31%. CONCLUSIONS A biopsy should always be obtained in cases suspected of EN because histology is a strong prognostic indicator and will help guide appropriate treatment. Unimodal surgery and combined surgery/radiotherapy appear to be of equivalent efficacy with respect to survival in patients with EN. Chemotherapy should be considered in high-grade EN.
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Affiliation(s)
- Ari J Kane
- Department of Neurological Surgery, University of California, San Francisco, California 94143, USA
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Brodmann S, Gyr Klaas E, Cathomas R, Girardi V, von Moos R. Severe hyponatremia in a patient with mantle cell lymphoma treated with bortezomib: a case report and review of the literature. Oncol Res Treat 2007; 30:651-4. [PMID: 18063878 DOI: 10.1159/000109979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hyponatremia is a known complication of cytotoxic treatment. We observed this side effect in a patient treated with bortezomib. This paper gives an overview of the literature on antineoplastic agents that have been associated with hyponatremia. CASE REPORT A 77-year-old female patient with mantle cell lymphoma was admitted with rapidly progressive ataxia, slurred speech, and confusion. 43 days earlier, a second-line treatment with the proteasome inhibitor bortezomib had been started. Neurological examination revealed no focal deficits. Laboratory evaluation showed a combined electrolyte disorder with severe hyponatremia (sodium 112 mmol/l). RESULTS A syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was diagnosed, and bortezomib was identified as its cause. The drug was consecutively stopped. CT scan showed a complete remission (CR). Since, the patient has remained in a CR without further tumor-specific treatment. CONCLUSION Hyponatremia may be a side effect of treatment with bortezomib and a number of other antineoplastic agents. Because of limited data available, accurate incidences of this complication are not known.
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Affiliation(s)
- Stefan Brodmann
- Abteilung Onkologie/Hämatologie, Departement Innere Medizin, Kantonsspital Graubünden, Chur, Switzerland
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Iyer AV, Krasnow SH, Dufour DR, Arcenas AS. Sodium-Wasting Nephropathy Caused by Cisplatin in a Patient with Small-Cell Lung Cancer. Clin Lung Cancer 2003; 5:187-9. [PMID: 14667276 DOI: 10.3816/clc.2003.n.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a case of severe hyponatremia following chemotherapy administration in a patient with small-cell lung cancer. There was no evidence of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The clinical and laboratory findings were consistent with a sodium-wasting nephropathy complicating cisplatin administration. There are few well-documented reports of cisplatin-associated hyponatremia in the medical literature. We have summarized the relevant literature and attempted to define the differential diagnosis of hyponatremia in this setting. Most cases are accounted for by sodium-losing nephropathy of SIADH, but many reported cases contain insufficient data for classification. Appropriate attention to the evaluation of hyponatremia following platinum-based chemotherapy is needed to properly treat these conditions.
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Affiliation(s)
- Akila V Iyer
- Veterans Affairs Medical Center, Washington, DC 20422, USA
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13
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Cao L, Joshi P, Sumoza D. Renal salt-wasting syndrome in a patient with cisplatin-induced hyponatremia: case report. Am J Clin Oncol 2002; 25:344-6. [PMID: 12151962 DOI: 10.1097/00000421-200208000-00005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hyponatremia after chemotherapy is not an uncommon clinical syndrome. Both renal salt-wasting syndrome (RSWS) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) have been reported as the underlying mechanisms for chemotherapy-induced hyponatremia. However, these two clinical syndromes have distinct clinical characteristics and managements. The key differential diagnostic feature for RSWS is the excessive urinary excretion of sodium, whereas the urinary excretion of sodium in SIADH is normal or decreased. The treatment for RSWS is supplement of salt, which is opposite to the treatment of SIADH. We report a case of a patient with hyponatremia and excessive urinary excretion of sodium after cisplatin-based chemotherapy. RSWS was diagnosed and the patient was treated with a sodium supplement. We also summarize the key diagnostic features and the most common differential diagnoses for hyponatremia syndrome.
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Affiliation(s)
- Lequn Cao
- Department of Medicine, UIC Medical Center, Chicago, Illinois, U.S.A
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14
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English MW, Skinner R, Pearson AD, Price L, Wyllie R, Craft AW. Dose-related nephrotoxicity of carboplatin in children. Br J Cancer 1999; 81:336-41. [PMID: 10496362 PMCID: PMC2362870 DOI: 10.1038/sj.bjc.6690697] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study investigated changes and the time course of these changes in renal function in children following treatment with carboplatin, and identified risk factors for nephrotoxicity. Glomerular and proximal renal tubular function were investigated before and up to 2 years after treatment in 23 children who received carboplatin. The main findings were reduced glomerular filtration rate (GFR), and increased renal tubular loss of magnesium, manifested by a low serum magnesium (S Mg). The mean fall in GFR was 22 ml min(-1) 1.73 m(-2) (P = 0.012), and in S Mg it was 0.17 mmol l(-1) (P = 0.0077). No patient had a clinically important reduction in GFR, and only one patient had symptomatic hypomagnesaemia. GFR and S Mg did not change over time after completion of treatment. Cumulative dose (CD) of carboplatin was inversely related to mean S Mg at the end of treatment (P = 0.031), and directly related to the fall in S Mg (P < 0.001). Calculated cumulative area under the plasma concentration versus time curve (AUC) of carboplatin was inversely related to S Mg after treatment (P = 0.004). Dose intensity (DI) of carboplatin was not shown to be related to S Mg following treatment. CD, AUC and DI of carboplatin were not related to GFR, nor change in GFR, after treatment. High CDs of carboplatin may be associated with evidence of renal damage qualitatively similar to but less severe than that caused by cisplatin. GFR and SMg should be carefully monitored when high CDs of carboplatin are used, or if carboplatin is combined with other nephrotoxic chemotherapy.
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Affiliation(s)
- M W English
- Sir James Spence Institute of Child Health, The Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Kleta R, Wagner A, Jürgens H. Recurrence of SIADH after a high-dose regimen of thiotepa, carboplatin, and etoposide phosphate. MEDICAL AND PEDIATRIC ONCOLOGY 1998; 31:129. [PMID: 9680945 DOI: 10.1002/(sici)1096-911x(199808)31:2<129::aid-mpo21>3.0.co;2-h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Hyponatremia is a common potential complication in cancer patients. It can be related to anticancer medical therapy. Vincristine, vinblastine, cisplatin and cyclophosphamide are the chemotherapeutic agents most frequently associated with hyponatremia. More recently, analogs such as carboplatin and ifosfamide have also been incriminated. Hyponatremia is also associated with new immunomodulators (interferon, interleukin-2 and levamisole) and monoclonal antibodies. The mechanism by which all these drugs act on the sodium steady state is only partially known. The syndrome of inappropriate antidiuretic hormone secretion is described secondary to vinca alkaloids and cisplatin and possibly with alkylating agents. Renal salt wasting is described with platinum compounds.
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Affiliation(s)
- T Berghmans
- Department of Internal Medicine, Institut Jules Bordet, Brussels, Belgium
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