德鲁克斯泰干诱导的可逆方科尼综合征
Pooja Kalantri1, Koba Lomashvili1
1General Nephrology, Emory University, Atlanta, USA.
Cureus
|July 26, 2023
概括
本病例报告详细介绍了Fanconi综合征,这是一种脏疾病,是由Trastuzumab+Deruxtecan (T-Dxt) 化疗引起的. 这突显了T-Dxt在癌症患者中罕见但严重的副作用.
科学领域:
- 在瘤学瘤学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
背景情况:
- 癌症治疗方案越来越复杂,导致严重的毒性.
- 癌症患者的急性或慢性病与较差的治疗结果和治疗效率降低有关.
- 特拉斯图祖马布+德鲁克斯坦 (T-Dxt) 是一种用于某些晚期癌症的联合化疗方案.
研究的目的:
- 报告Trastuzumab+Deruxtecan (T-Dxt) 化疗后的第一个已知Fanconi综合征病例.
- 在患有转移性乳腺癌的患者中研究与T-Dxt相关的潜在毒性.
主要方法:
- 一个74岁的患有转移性乳腺癌的妇女的案例研究,在开始T-Dxt.后出现严重的电解质异常.
- 临床评估,实验室检测 (血清和尿液电解质,尿液分析),并审查患者的治疗史.
- 将Fanconi综合征归因于Deruxtecan成分,基于之前没有不良事件的Trastuzumab单疗法.
主要成果:
- 患者呈现出严重的低血,低血,代谢性酸症,低磁血和低血.
- 尿液分析显示葡萄糖尿,蛋白尿,以及和损失的迹象,符合Fanconi综合征.
- 电解质异常归因于T-Dxt,并在治疗停止或修改后几个月内消失.
结论:
- 特拉斯图祖马布+德鲁克斯坦 (T-Dxt) 可以诱导Fanconi综合征,这是一个罕见但显著的脏不良事件.
- 这一案例强调了在接受T-Dxt.的患者中监测功能和电解质平衡的重要性.
- 早期识别和管理化疗诱导的毒性对于患者的治疗结果至关重要.
相关概念视频
01:11Renal Failure: Dose Adjustments
122
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
122
01:28Renal Drug Excretion: Tubular Secretion
224
Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...
224
01:25Renal Drug Excretion: Tubular Reabsorption
222
Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...
222
01:30Continuous Renal Replacement Therapy
54
Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
54
01:24Renal Tubule and Collecting Duct
1.1K
The renal tubule is divided into three parts: the proximal convoluted tubule (PCT), the Loop of Henle (LOH), and the distal convoluted tubule (DCT).
Proximal Convoluted Tubule (PCT):
The PCT is the initial segment of the renal tubule, extending from the Bowman's capsule that encloses the glomerulus. Its convoluted structure and microvilli-lined cells increase the surface area for reabsorption. The PCT reabsorbs glucose, amino acids, sodium, and water from the filtrate, ensuring essential...
Proximal Convoluted Tubule (PCT):
The PCT is the initial segment of the renal tubule, extending from the Bowman's capsule that encloses the glomerulus. Its convoluted structure and microvilli-lined cells increase the surface area for reabsorption. The PCT reabsorbs glucose, amino acids, sodium, and water from the filtrate, ensuring essential...
1.1K
01:15Renal Drug Excretion: Overview
185
As primary excretory organs, the kidneys maintain homeostasis by removing waste substances from the bloodstream. They comprise over a million units called nephrons, which serve as the kidney's functional units.
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules...
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules...
185