Abstract: SA-PO981

Acquired Erythropoietin (EPO) Deficiency Following Microwave Ablation of Papillary Renal Cell Carcinoma in a Renal Transplant

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Vela-Ortiz, Myriam C., Drexel University, Philadelphia, Pennsylvania, United States
  • Brezin, Joseph H., Clinical Nephrology VA Associates, LTD, Philadelphia, Pennsylvania, United States
  • Bianco, Brian A, Hahnemann University Hospital, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
Background

Percutaneous microwave ablation of renal malignancies is a novel nephron sparing option for patients who are poor candidates for surgical resection. We present the development of acquired EPO deficiency following microwave ablation of papillary renal cell cancer in a renal allograft.

Methods

A 48-year-old Caucasian female with a PMH of acute post streptococcal glomerulonephritis developed progressive CKD over the next 8 years. She was dependent on recombinant EPO for anemia of CKD for one year prior to renal transplantation in 1995. She received an HLA identical renal transplant from her brother. Her hemoglobin over the next 21 years was normal (12.5-14 gm/dL) without further EPO. The patient was maintained on immunosuppression with cyclosporine, mycophenolate mofetil, and prednisone. Her serum creatinine was 1.5 to 1.7 mg/dl in the first half of 2016. During a work up for resistant hypertension, a 2 x 1.6 cm contrast enhancing mass was found in the lower pole of her kidney transplant. Needle biopsy revealed a low grade papillary renal cell carcinoma. The lesion was treated with microwave ablation as renal sparing therapy. Concurrently the patient was found to have a 7 cm mass of the left native kidney that was treated with laparoscopic radical nephrectomy, also a papillary renal cell carcinoma. Imaging studies 6 months later showed a defect in the lower pole of the renal allograft with no blood flow or contrast enhancement. She developed a normocytic anemia with normal iron studies over the next 3 months and was hospitalized for symptomatic anemia: hemoglobin 6.9 g/dL, WBC 7.3 mm3, platelet count 252, and reticulocyte count 1.4 %. The EPO level was exceedingly low at 7 mlU/L. The bone marrow was hypo cellular on biopsy. She was treated with a blood transfusion followed by judicious recombinant EPO supplementation to avoid further transfusions. Her current hemoglobin is 9.5 gm/dL and her serum creatinine is 1.97 mg/dL.

Conclusion

Herein we present the case of a patient with papillary renal cell carcinoma of her renal transplant that was successfully treated with microwave ablation. However, she subsequently developed EPO deficiency with severe anemia. We suggest that this may represent a heat related injury to a single functioning kidney that attenuated the production of erythropoietin.