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Case Study: Renal Failure Secondary to Pancreatic Metastases From Kidney Cancer

By: Dana A. Elya, MS, RD, CDN
Posted: Thursday, January 2, 2020

An 84-year-old man, who experienced unexpected renal failure while receiving treatment for metastatic renal cell carcinoma, was the focus of a case report identifying the importance of monitoring toxicities and the potential consequences of pancreatic insufficiency and its sequelae in patients with pancreatic metastases. The report was published in BMC Cancer by Karin Purshouse, MD, of the Churchill Hospital at Oxford University, and colleagues.

In the case report, 15 years after right radical nephrectomy, the patient presented with iron deficiency anemia. An esophagogastroduodenoscopy was preformed, and metastatic clear cell renal carcinoma was confirmed. The patient was prescribed 800 mg of the tyrosine kinase inhibitor pazopanib once daily as first-line treatment.

After 3 months, the patient’s CT scan showed disease response, but he had a decreased appetite, diarrhea, and fatigue. Pazopanib was reduced to 400 mg once daily. At 9 months of treatment, the patient experienced severe diarrhea and dehydration, as well as decreased renal function, and the pazopanib treatment was held.

Once renal function was stabilized, a renal biopsy was performed. A large number of interstitial oxalate crystals were found. A 24-hour urine collection identified high oxalate excretion, and fecal elastase-1 was reduced—both consistent with pancreatic exocrine insufficiency. It was identified that the cause of the renal impairment was the result of secondary oxalate nephropathy from pancreatic exocrine insufficiency due to the pancreatic metastatic lesions.

In closing, the authors related the “importance of considering renal biopsy in patients in whom the cause of progressive renal failure is unclear, and that treatment with tyrosine kinase inhibitors can be continued safely under close observation, as in this case.”

Disclosure: The study authors’ disclosure information can be found at biomedcentral.com.



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