Abstract: PUB213
Abiraterone-Induced Rhabdomyolysis as an Unusual Cause of AKI Requiring Hemodialysis
Session Information
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Author
- Garcia Yanez, Juan Carlos, Hospital Aranda de la Parra, Leon, Guanajuato, Mexico
Introduction
A 86-year-old male diagnosed with metastatic, castration-resistant prostate cancer (mCRPC) treated with abiraterone (Zitiga) for 3 months was admited to the emergency department due to hyporexia, worsening fatigue and lethargy.
Case Description
After being diagnosed with prostate cancer, the patient had been subject to a radical prostatectomy 10 years prior to admission; 12 months prior to admission he developed deep-vein thrombosis that required endovascular treatment. The patient was prescribed daily 10mg rivaroxaban and 5mg prednisone for 1 year. For over 4 years, the patient had an irregular consumption of esomeprazole, atorvastatin and risperidone.
Upon admission to the emergency department laboratory analysis revealed a dialytic emergency: serum creatinine of 6.1mg/dL, urea 295 mg/dL, BUN 138mg/dL and potassium of 7.3mEq/L. The patient refused renal replacement therapy. Agressive hydration and treatment with calcium gluconate, IV insulin and beta-agonist micronebulizations were prescribed to treat hyperkalemia.
24 hours later the patient persisted with serum creatinine 5.8, urea 276, BUN 128 and potassium of 7.0 despite optimal hydration management and potassium-lowering measures. As the clinical status didn't improve wiwth the previously described measures, the patient agreed to hemodialysis.
Neurological symptoms improved, but the patient persisted with localized muscle pain in both legs, and it was decided to measure myolisis enzymes, with the following results: CPK 425 CPK-MB 92 and Myoglobin of 500 ng/mL. (7 times over the reference value). The patient was subject to three additional hemodialysis sessions, until creatinine, urea, BUN, K, CPK, and myoglobin levels were at reference parameters.
The patient was discharged and at the follow-up appointment one month later he had complete resolution of symptoms and laboratory values, with the following parameters: serum creatinine 1.6 mg/dL urea 47.9 mg/dL BUN 13 mg/DL, K 4.1 mEq/L, myoglobin 41 ng/mL, CPK 34 U/L.
Discussion
There are only a few case reports that describe an association betweent abiraterone and rhabdomyolysis requiring renal replacement therapy. In Mexico, this is the first reported case. It is an important lesson, particularly in an oncologic hospital, as this unusual cause of acute kidney injury may be under-recognized in patients with prostate cancer undergoing treatment with this medication.