Abstract: FR-PO006

AKI Secondary to Trabectedin Induced Rhabdomyolysis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Amberker, Deepa, Washington University in St. Louis, St. Louis, Missouri, United States
  • Katari, Sreelatha, Washington University in St. Louis, St. Louis, Missouri, United States
  • Vijayan, Anitha, Washington University in St. Louis, St. Louis, Missouri, United States
Background

Onconephrology is a growing field with nephrologists being consulted for various renal issues. Chemotherapy(chemotx) is associated with multiple renal complications including TMA, AIN, electrolyte abnormalities and CKD. Rhabdomyolysis (rhabdo) secondary to chemotx is extremely rare. We report a case of severe AKI secondary to rhabdo from trabectidin, an alkylating agent approved for soft tissue sarcomas in 2015.

Methods

A 46 year old Caucasian male with relapse of retroperitoneal liposarcoma was started on trabectedin 4wk prior to admission. He presented with 10d history of n/v, diarrhea, chest pain and sob, starting a week after his 2nd cycle of trabectedin given 1wk before admission. Initial labs showed pancytopenia, Trop-I of 0.15 and SCr of 1.4 (baseline 1.1). On day 9, SCr started increasing and peaked at 5.61. Creatinine kinase (CK) was obtained and noted to be elevated and peaked at 93300. He was treated with bicarbonate drip with subsequent improvement in renal function.(Table1)

Conclusion

Trabectedin has been associated with pancytopenia, myocarditis, transaminitis and GI side effects. In the company drug data base, rhabdo has only been reported in 0.7% of cases, but had a high mortality of 41%. CK elevation is typically reported after the 2nd cycle and rare after the 4th cycle. Median time to CK elevation was 2mo post chemotx.Trabectidin undergoes hepatic metabolism and inhibitors of CYP3A4 increase risk for adverse events. Our patient was not on any medications which is known to inhibit this pathway. With increasing use of trabectedin in soft tissue sarcomas, it is critical that physicians be aware of this devastating complication and monitor patients closely during chemotx. Early, adequate hydration , frequent lab checks including SCr and CK is crucial in preventing AKI and its complications.

Lab Trend
Labs1 week before admissionDay 1 of admissionDay 9 of admissionDay 18 of admission ( peak values At Discharge (day 35 )
SCr (mg/dl )1.101.401.955.610.9
K (mmol/l)3.54.13.73.53.5
Ca (mg/dl )8.87.87.2<58.2
Phos
( mg/dl )
2.3--7.5
3
Trop(ngml )-0.158.316-
CK
( units/l )
55177815493300161
AST (units/l )4819812031665119
ALT (units/l )9634042286273
ALP (units/l )8320717826477
Uric acid (mg/dl )5--16.87