A. ALP, H. AKDAM, H. AKAR, Y. YENİÇERİOĞLU, A. ÜNSAL, Ö. UYANIK, M. AYHAN, N. ÇULHACI

Renal hücreli karsinom tanılı bir olguda tekrarlayan hiperkalemi atakları

Hiperkalemi klinik pratiğin en önemli acillerinden biridir. Bu önemini ölümcül olabilen kardiyak etkilerinden almaktadır. Tekrarlayan hiperkalemi nadir görülür ve genellikle nefrolojik kökenlidir. Renal tübüler asidozlar da bunlardan biridir. Tip 4 renal tübüler asidoz genelde diabetes mellitusla birliktelik göstermekle beraber birçok klinik duruma eşlik edebilir. Renal hücreli karsinom erişkinlerde böbreğin en sık görülen malign tümörüdür. Son dönemlerde sunitinib ileri evre renal hücreli karsinom tedavisinde sıkça kullanılmaktadır. Bazen hastalarda hiperkalemiye katkıda bulunan birden fazla etken olabilir.

Recurrent episodes of hyperkalemia in a case with renal cell carcinoma

Hyperkalemia is one of the most urgent entities in clinical practice. The importance of hyperkalemia arises from its cardiovascular effects that can be mortal. Relapsing hyperkalemia is rare and usually associated with renal disorders. Renal tubular acidosis is one of them. Although Type 4 renal tubular acidosis is generally associated with diabetes mellitus, this entity also may accompanied by other disorders. Renal cell carcinoma is the most common type of kidney cancer in adults and recently sunitinib is being widely used in advanced renal cell carcinoma. Sometimes hyperkalemia may be caused by multiple contributing factors.

PDF

___

1. Palapattu GS, Kristo B, Rajfer J. Paraneoplastic syndromes in urologic malignancy: The many faces of renal cell carcinoma. Rev Urol 2002;4(4):163-70.
2. Saitoh H. Distant metastasis of renal adenocarcinoma. Cancer 1981;48(6):1487-91.
3. Choueiri TK, Bellmunt J. Sunitinib in renal-cell carcinoma: expanded indications. The Lancet Oncology 2009;10(8):740.
4. Nicholaou T, Wong R, Davis ID. Tumour lysis syndrome in a patient with renal cell carcinoma treated with sunitinib malate. Lancet 2007;369(9577):1923-4.
5. Michels J, Lassau N, Goupil MG, Massard C, Mejean A, Escudier B. Sunitinib inducing tumor lysis syndrome in a patient treated for renal carcinoma. Invest New Drugs 2010;28(5):690-3.
6. Yoshino T, Kawai K, Miyazaki J, et al. A case of acute adrenal insufficiency unmasked during sunitinib treatment for metastatic renal cell carcinoma. Jpn J Clin Oncol 2012;42(8):764-6.
7. Rock EP, Goodman V, Jiang JX, et al. Food and Drug Administration drug approval summary: Sunitinib malate for the treatment of gastrointestinal stromal tumor and advanced renal cell carcinoma. Oncologist 2007;12(1):107-13.
8. Highlights of Prescribing Information, SUTENT (sunitinib malate) Capsules, Oral. Reference ID:3217597. Food and Drug Administration. (Available from: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm224050.html)
9. Choi MJ, Ziyadeh FN. The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. J Am Soc Nephrol 2008;19(3):424-6.
10. Karet FE. Mechanisms in hyperkalemic renal tubular acidosis. J Am Soc Nephrol 2009;20(2):251-4.
11. Golembiewska E, Ciechanowski K. Renal tubular acidosis-underrated problem? Acta Biochim Pol 2012;59(2):213-7.
12. Li SL, Liou LB, Fang JT, Tsai WP. Symptomatic renal tubular acidosis (RTA) in patients with systemic lupus erythematosus: An analysis of six cases with new association of type 4 RTA. Rheumatology 2005;44(9):1176-80.