Johnathan Ngo1, Peter Fox2, Balasubramania Indrajit3, James Collett3
1Liverpool Hospital, Liverpool, Australia, 2Central West Cancer Care Centre, Orange, Australia, 3Dubbo Base Hospital, Dubbo, Australia
Biography:
Dr Johnathan Ngo is a recently fellowed Nephrologist and the current Transplant Fellow at Liverpool hospital. His special interests include general nephrology, renal transplantation, health informatics and data analytics. He is actively involved in the provision of medical education.
Background:
Secondary hyperoxaluria from octreotide therapy is rare but can cause nephrolithiasis and significant kidney injury. We describe a case that has led to significant CKD possibly potentiating the need for dialysis.
Case Report:
A 73-year-old male with known mesenteric neuroendocrine tumour with nodal and hepatic metastases was commenced on monthly octreotide. His background history was relevant for type two diabetes. Treatment led to improvement in tumour burden but triggered recurrent oxalate stone formation, leading to multiple acute kidney injuries and progressive chronic kidney disease. Management of recurrent obstructive nephropathy involved multiple interventions, including ureteric stenting and replacements, nephrostomy tube insertions, and laser lithotripsy. Octreotide was discontinued, however, ongoing urological intervention in the setting of consistent renal function decline was required. Off treatment, his neuroendocrine tumour has remained stable. In addition to his stone burden, his obstructive renal injury was worsened by the discovery of metastatic prostate adenocarcinoma with bladder invasion leading to left ureteric obstruction in addition to a sclerotic L5 lesion. He underwent a transurethral resection of the prostate and was commenced on androgen-deprivation therapy. Over 4 years, his creatinine has increased from 115 μmol/L to 398 μmol/L.
Conclusion:
Octreotide is a rare cause of secondary oxalate nephropathy that can lead to significant, irreversible, renal injury. As the field of onco-nephrology continues to grow, it is crucial that this complication is recognised promptly to help guide optimal treatment.