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Sunitinib-associated hyperammonemic encephalopathy successfully managed with higher intensity conventional hemodialysis: A case report.
- Source :
-
Medicine [Medicine (Baltimore)] 2021 Feb 05; Vol. 100 (5), pp. e24313. - Publication Year :
- 2021
-
Abstract
- Rationale: Hyperammonemia encephalopathy is a rare but severe complication that has been reported in association with the use of sunitinib, a tyrosine kinase inhibitor. We report here a unique case of a patient with end stage renal disease that was initiated on sunitinib for metastatic renal cell carcinoma.<br />Patient Concerns: A 65-year-old man with end stage renal disease on maintenance conventional hemodialysis and had concomitant stable Child-Pugh class B liver cirrhosis consequent of hepatitis C infection was started on sunitinib for metastatic renal cell carcinoma. He developed confusion few weeks after starting therapy with no other indication of worsening liver dysfunction otherwise.<br />Diagnosis: He was later diagnosed with hyperammonemia encephalopathy.<br />Interventions: His treatment was discontinued and reinitiated at a lower dose after recovery and titrated according to tolerance. As ammonia is a very low molecular weight molecule and is cleared well with diffusive clearance, we intensified his dialysis regimen by increasing intensity for each session and frequency per week.<br />Outcomes: With this change in dialysis regimen, patient was able to continue treatment with sunitinib.<br />Lessons: Clinicians prescribing sunitinib should be vigilant to monitor for this complication in patients receiving sunitinib, apart from the more usual presentation of hepatotoxicity. We found that a more intensive hemodialysis regimen consisting of 4× a week conventional high-flux hemodialysis (HD) can permit the continuation of treatment with sunitinib in an end stage renal disease (ESRD) patient with Child-Pugh class B liver cirrhosis.<br />Competing Interests: The authors have no conflicts of interest to disclose.<br /> (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Subjects :
- Aged
Carcinoma, Renal Cell virology
Hepacivirus
Hepatitis C complications
Humans
Kidney Failure, Chronic complications
Kidney Failure, Chronic therapy
Kidney Neoplasms virology
Liver Cirrhosis virology
Male
Renal Dialysis
Antineoplastic Agents adverse effects
Carcinoma, Renal Cell drug therapy
Hyperammonemia chemically induced
Kidney Neoplasms drug therapy
Neurotoxicity Syndromes etiology
Sunitinib adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 100
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 33592876
- Full Text :
- https://doi.org/10.1097/MD.0000000000024313