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Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis
Cyclophosphamide is frequently used to treat cancer, autoimmune and renal diseases, such as rapidly progressive glomerulonephritis. Its side effects are well-known, including bone marrow depression, infections, alopecia, sterility, bladder malignancy and hemorrhagic cystitis. Moreover, in some cases...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Baishideng Publishing Group Inc
2017
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500459/ https://www.ncbi.nlm.nih.gov/pubmed/28729970 http://dx.doi.org/10.5527/wjn.v6.i4.217 |
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author | Esposito, Pasquale Domenech, Maria Valentina Serpieri, Nicoletta Calatroni, Marta Massa, Ilaria Avella, Alessandro La Porta, Edoardo Estienne, Luca Caramella, Elena Rampino, Teresa |
author_facet | Esposito, Pasquale Domenech, Maria Valentina Serpieri, Nicoletta Calatroni, Marta Massa, Ilaria Avella, Alessandro La Porta, Edoardo Estienne, Luca Caramella, Elena Rampino, Teresa |
author_sort | Esposito, Pasquale |
collection | PubMed |
description | Cyclophosphamide is frequently used to treat cancer, autoimmune and renal diseases, such as rapidly progressive glomerulonephritis. Its side effects are well-known, including bone marrow depression, infections, alopecia, sterility, bladder malignancy and hemorrhagic cystitis. Moreover, in some cases cyclophosphamide use has been related to the onset of hyponatremia, by development of a syndrome of inappropriate antidiuresis. Indeed, severe hyponatremia has been previously reported in patients treated with high-dose or moderate-dose of intravenous cyclophosphamide, while only few cases have been reported in patients treated with low dose. Here, we discuss a case of a syndrome of inappropriate antidiuresis followed to a single low-dose of intravenous cyclophosphamide in a patient with a histological diagnosis of acute glomerulonephritis, presenting as acute kidney injury. After cyclophosphamide administration (500 mg IV), while renal function gradually improved, the patient developed confusion and headache. Laboratory examinations showed serum sodium concentration dropped to 122 mmol per liter associated with an elevated urinary osmolality of 199 mOsm/kg, while common causes of acute hyponatremia were excluded. He was successfully treated with water restriction and hypertonic saline solution infusion with the resolution of the electrolyte disorder. This case, together with the previous ones already reported, highlights that electrolyte profile should be strictly monitored in patients undergoing cyclophosphamide therapy in order to early recognize the potentially life-threatening complications of acute water retention. |
format | Online Article Text |
id | pubmed-5500459 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-55004592017-07-20 Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis Esposito, Pasquale Domenech, Maria Valentina Serpieri, Nicoletta Calatroni, Marta Massa, Ilaria Avella, Alessandro La Porta, Edoardo Estienne, Luca Caramella, Elena Rampino, Teresa World J Nephrol Case Report Cyclophosphamide is frequently used to treat cancer, autoimmune and renal diseases, such as rapidly progressive glomerulonephritis. Its side effects are well-known, including bone marrow depression, infections, alopecia, sterility, bladder malignancy and hemorrhagic cystitis. Moreover, in some cases cyclophosphamide use has been related to the onset of hyponatremia, by development of a syndrome of inappropriate antidiuresis. Indeed, severe hyponatremia has been previously reported in patients treated with high-dose or moderate-dose of intravenous cyclophosphamide, while only few cases have been reported in patients treated with low dose. Here, we discuss a case of a syndrome of inappropriate antidiuresis followed to a single low-dose of intravenous cyclophosphamide in a patient with a histological diagnosis of acute glomerulonephritis, presenting as acute kidney injury. After cyclophosphamide administration (500 mg IV), while renal function gradually improved, the patient developed confusion and headache. Laboratory examinations showed serum sodium concentration dropped to 122 mmol per liter associated with an elevated urinary osmolality of 199 mOsm/kg, while common causes of acute hyponatremia were excluded. He was successfully treated with water restriction and hypertonic saline solution infusion with the resolution of the electrolyte disorder. This case, together with the previous ones already reported, highlights that electrolyte profile should be strictly monitored in patients undergoing cyclophosphamide therapy in order to early recognize the potentially life-threatening complications of acute water retention. Baishideng Publishing Group Inc 2017-07-06 2017-07-06 /pmc/articles/PMC5500459/ /pubmed/28729970 http://dx.doi.org/10.5527/wjn.v6.i4.217 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Case Report Esposito, Pasquale Domenech, Maria Valentina Serpieri, Nicoletta Calatroni, Marta Massa, Ilaria Avella, Alessandro La Porta, Edoardo Estienne, Luca Caramella, Elena Rampino, Teresa Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis |
title | Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis |
title_full | Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis |
title_fullStr | Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis |
title_full_unstemmed | Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis |
title_short | Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis |
title_sort | severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500459/ https://www.ncbi.nlm.nih.gov/pubmed/28729970 http://dx.doi.org/10.5527/wjn.v6.i4.217 |
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