Abstract: TH-PO073
Karyomegalic Interstitial Nephritis in a Patient Treated with Ifosfamide
Session Information
- AKI: Liver Disease, Nephrotoxicity, Novel Therapeutics
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Gudlawar, Sirisha, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction
Ifosfamide is an alkylating used in treating wide variety of cancers including germ line tumors of testes, soft tissue sarcomas, bladder cancer and cervical cancer. It can lead to reversible Fanconi syndrome, acute kidney injury (AKI). Here in, we present a case of karyomegalic interstitial nephritis (KIN) in a patient treated with ifosfamide.
Case Description
47-year-old female with history significant for high grade extra skeletal osteosarcoma underwent tumor resection with flap reconstruction. She was started on chemotherapy with Adriamycin, Ifosfamide, Mesna and received a total of three cycles of chemotherapy. She developed AKI with creatinine of 1.5 mg/dl (baseline creatinine of 0.8 mg/dl) along with hypokalemia, hypophosphatemia and metabolic acidosis, due to which Nephrology consultation was sought. Her blood pressure was 143/78 mmHg, Heart rate of 79 beats per minute. Urine analysis was performed which showed glucosuria and microscopy was bland. Initial sodium was 141 mmol/L, potassium 2.8 mmol/L, chloride of 116 mmol/L, bicarbonate 16 mmol/L, blood urea nitrogen 12 mg/dL, Serum creatinine ( SCr) of 1.59 mg/dL, phosphorus 1.5 mg/dL. She was treated conservatively with electrolyte supplementation and intravenous fluids, discharged home with outpatient follow up. Due to progressive decline in renal function ( SCr 2.2 mg/dL) she underwent biopsy which showed chronic interstitial nephritis with karyomegalic features, and severe interstitial fibrosis and tubular atrophy (IFTA 70%) .She was started on steroids and creatinine improved to 1.7 mg/dL. Thereafter, her creatinine remained steady at 2 mg/dL. There was no recurrence of cancer and is currently in remission.
Discussion
KIN is a rare form of familial interstitial nephritis, As per previous case reports, AKI occurs between 12 months to 5 years after exposure to the drug. In our case, it was 3 months after the initiation of chemotherapy. About 40% of these patients respond favorably to corticosteroids where as those with chronic tubulointerstitial nephritis responded poorly. This case report illustrates the importance of performing early kidney biopsy with persistent renal dysfunction following chemotherapy. Early diagnosis and initiation of steroids could potentially recover kidney function or prevent the progression of the disease.