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Clinically silent progressive renal tubulointerstitial disease during cisplatin chemotherapy
D G Guinee1, B van Zee, D C Houghton
1Department of Pathology, Oregon Health Sciences University, Portland.
Background:
Chronic cisplatin nephrotoxicity is well documented in animal models but not well characterized in humans. The authors report a 56-year-old woman who had end-stage chronic tubulointerstitial nephropathy develop during treatment with multiple courses of cisplatin chemotherapy for ovarian carcinoma.
Methods:
A biopsy was performed to determine the etiology of renal failure, and the morphologic, immunofluorescent, and ultrastructural findings were analyzed to identify possible causes, other than cisplatin, of chronic renal disease.
Results:
Morphologic studies showed extensive renal tubulointerstitial fibrosis with relative sparing of glomeruli.
Conclusions:
Profound, progressive renal injury occurred during cisplatin treatment despite adherence to treatment protocols designed to minimize such toxicity. Renal injury was undetected by pretreatment serum creatinine determinations. This case and others emphasize the relative insensitivity of this test for chronic renal damage during treatment with nephrotoxic drugs.