Abstract: PUB010
Unraveling the Hidden Impact: A Case Report on Enzalutamide-Induced Electrolyte Abnormalities
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Hirani, Chetna N, Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Kohli, Aditya, Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Bethea, Meaghan, Ross Medical Education Center - Ann Arbor, Ann Arbor, Michigan, United States
- Giddings, Sara, Ross Medical Education Center - Ann Arbor, Ann Arbor, Michigan, United States
- Ramamurthi, Kalyana S., Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Al-Saghir, Fahd, Trinity Health Oakland Hospital, Pontiac, Michigan, United States
Introduction
Enzalutamide is commonly used to treat metastatic castration-resistant prostate cancer (mCRPC), but its complete effects on renal function and electrolyte levels are not fully understood. While most reported side effects are neurological or metabolic, enzalutamide has also been linked to disturbances in electrolytes, which may lead to renal dysfunction. This case illustrates a significant occurrence of acute kidney injury and electrolyte imbalances likely associated with enzalutamide therapy.
Case Description
A 66-year-old male with metastatic prostate cancer had been on enzalutamide for seven months. During a routine oncology follow-up, he presented with acute kidney injury. Laboratory tests revealed severe hypercalcemia (14.3 mg/dL), hypermagnesemia (5.6 mg/dL), hyperphosphatemia (5.2 mg/dL), and a creatinine level of 6.95 mg/dL, compared to his baseline of 0.7 mg/dL. Additionally, he was taking high doses of NSAIDs for bone pain and was on calcium and vitamin D supplements. Enzalutamide was suspected to contribute to his metabolic abnormalities and was discontinued upon admission. With IV hydration and supportive care, his electrolyte imbalances gradually resolved, and his kidney function improved. At discharge, enzalutamide remained discontinued, and follow-up lab results showed a creatinine level of 1.07 mg/dL, calcium at 9.4 mg/dL, and mild residual hypermagnesemia.
Discussion
This case highlights the potential for enzalutamide to disrupt electrolyte balance and worsen renal injury. The patient's hypercalcemia was likely caused by a combination of factors, including bone metastases and the effects of medication. Additionally, hypermagnesemia and hyperphosphatemia resulted from impaired renal clearance. Enzalutamide may negatively affect the renal tubular handling of electrolytes through androgen receptor inhibition and channel dysfunction. Therefore, clinicians should closely monitor kidney function and electrolyte levels in patients taking enzalutamide, especially if they are using other nephrotoxic medications or supplements. Early detection and review of medications can help prevent complications and ensure the safe continuation of cancer treatment.