ALICE DOLAN1, LINDA YE2, REVATHY MANICKAVASAGAR1
1Department of Nephrology, Royal Perth Hospital, , Australia, 2Department of Oncology, Royal Perth Hospital , , Australia
Biography:
Bio to come
Background:
Thrombotic microangiopathy (TMA) is characterised by thrombocytopaenia, microangiopathic haemolytic anaemia and end organ dysfunction, most commonly affecting the kidneys. TMA secondary to prostate cancer is rare and the pathogenesis is poorly understood. While there is no standardised approach to treatment, limited published cases report use of hormonal therapies, dialysis, transfusions, plasma exchange, steroids and eculizumab.
Case report:
A 73 year old man presented with painless macroscopic haematuria, vomiting, anorexia and generalised lethargy. He had a recent radiological diagnosis of prostate cancer and was awaiting urology review. Initial evaluation revealed thrombocytopaenia, haemolysis and acute kidney injury. A diagnosis of TMA was suspected, thought to be secondary to metastatic prostate cancer given his otherwise negative TMA screen. Haemodialysis was commenced due to deteriorating renal function with oliguria and uraemia. With progressive anaemia and thrombocytopenia prostate and kidney biopsy was deferred due to bleeding risk. In consultation with oncology and urology, he was commenced on empirical therapy with gonadotropin-releasing hormone (GnRH) antagonist Degarelix. Given the screen for TMA did not demonstrate thrombotic thrombocytopaenic purpura or atypical haemolytic uraemic syndrome, he did not undergo plasma exchange or receive eculizumab. With hormonal treatment targeting the underlying malignancy and supportive care only, our patient had full resolution of his thrombocytopaenia and haemolysis and ceased haemodialysis.
Conclusions:
While there is no standard treatment for prostate cancer related TMA, previous cases have suggested a role for plasma exchange and eculizumab in the management. This case demonstrates successful treatment of prostate cancer related TMA targeting the underlying malignancy and providing supportive care only, which has rarely been described.