RESUMEN
Various classes of targeted therapies have emerged in the last few years, which have revolutionized cancer treatment, and improved the prognosis and survival of cancer patients. Unfortunately, these agents have serious toxic effects on the kidneys. Some of the toxic effects are hypertension, acute kidney injury (AKI), and proteinuria. One interesting phenomenon that has emerged recently is pseudo-acute kidney injury due to the interference with the tubular secretion of creatinine by some of the targeted therapeutic agents. Understanding this physiology is needed to avoid unnecessary investigation and withholding of lifesaving chemo regimen. Alternative methods to assess renal function such as cystatin C-based estimated glomerular filtration rate (eGFR) can differentiate true AKI from pseudo-AKI. Here, we describe one such case of pseudo-AKI from cyclin-dependent kinase (CDK) 4/6 inhibitor, abemaciclib, which inhibits tubular secretion of creatinine. Using cystatin-C-based eGFR revealed pseudo-AKI in this case.
RESUMEN
BACKGROUND: Urinary ascites represents a scarcely observed pseudo-acute kidney injury in clinical settings. Protracted or missed diagnosis may hold grave ramifications for patient outcomes. CASE PRESENTATION: We reported a case involving an elderly female patient experiencing pseudo-acute kidney injury accompanied by ascites, wherein her renal dysfunction persisted despite medical intervention and hemodialysis. Urinary ascites was identified via a methylene blue test and by contrasting creatinine levels in serum and ascites. This patient's kidney function was multiple typified by a marked elevation in serum creatinine/Cystatin C ratio (> 2 L/dL), potentially serving as a clue for the clinical diagnosis of pseudo-acute kidney injury engendered by urinary ascites. CONCLUSIONS: This case suggested the potential diagnostic value of an asynchronous increase in serum creatinine and serum CysC (or an increased ratio of blood creatinine to blood CysC) in patients with pseudo-acute kidney injury.
Asunto(s)
Lesión Renal Aguda , Cistatina C , Humanos , Femenino , Anciano , Ascitis/diagnóstico , Ascitis/etiología , Creatinina , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Diagnóstico ErróneoRESUMEN
Acute kidney injury (AKI), a common diagnosis in the emergency department, is defined as a reduction in renal filtration function, with decrease in urine output, increase in serum creatinine, or both. However, a rise in serum creatinine can occur without AKI: the principal cause of a pseudo-AKI is urinary ascites, caused by urinary tract rupture, followed by reverse intraperitoneal dialysis and resorption of creatinine. The intraperitoneal leak of free urine is mainly traumatic, and half of the cases are iatrogenic. A case of intraperitoneal bladder rupture after minor trauma is presented with a review of the pathology of pseudo-AKI.