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Kidney Week

Abstract: PO0242

AKI due to Renal Limited Thrombotic Microangiopathy (TMA) in a Patient with Metastatic Prostate Cancer

Session Information

  • AKI Mechanisms - 3
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 103 AKI: Mechanisms

Authors

  • Gerardine, Supriya, New York Presbyterian - Weil Cornell, New York, New York, United States
  • Abramson, Matthew, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
  • Latcha, Sheron, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction

In this report we describe a case of AKI caused by TMA without evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia as a paraneoplastic syndrome due to metastatic prostate cancer versus radiation injury.

Case Description

65 year old man with metastatic prostate cancer treated with hormonal therapy, Cabazitaxel (last dose 5 months ago) and radiation to the prostate, T-12-L5 and pelvic region was admitted for gastrointestinal bleed and AKI.
He was hypertensive to 182/82 mmHg and labs with white blood cell count 13.8 K/mcL, hemoglobin 6.7g/dl, platelets 228 K/mcl and Creatinine 2.3mg/dl (baseline 0.6 mg/dl).Urine sodium was 54 meq/L, creatinine 57 mg/dl and proteinuria of 4.9g/day.Peripheral smear had 2-3 schistocytes per high power field. Lactate dehydrogenase was 449 U/L , haptoglobin 155 mg/dL and ADAMTS13 level 47%.
Renal ultrasound showed mild right hydronephrosis.He was given blood,intravenous fluids and right percutaneous nephrostomy was place but creatinine rose to 5mg/dl so renal biopsy was done.
The specimen had 120 glomeruli and 12 were sclerosed There was focal organizing arterial and arteriolar thrombi. C5b-9 positive staining was seen within the affected glomeruli and most arteriolar walls and tubular basement membranes. There was no immune complex electron dense deposits.This was indicative of severe,acute, subacute and chronic TMA involving all small arterial vessels with acute tubular necrosis.
The patient required hemodialysis without renal recovery.

Discussion

TMA is reported in metastatic adenocarcinomas.Cancer treatment can also lead to TMA’s. Cabazitaxel was unlikely etiology for the TMA as it had been a few months since the last dose.There are no cases reported of radiation causing renal limited TMA which we thought could also be a potential cause.Hypertension and severe anemia with schistocytes were the only clues to a TMA process.The elevated haptoglobin and normal platelet count was unusual. The TMA is thought to be likely secondary to paraneoplastic syndrome or possibly from the radiation treatments.