内容紹介
Life-Threatening Hyponatremia by Chemotherapy in a Patient with Non-Hodgkin's Lymphoma
Summary
Cyclophosphamide and vincristine are known to be the chemotherapeutic agents most frequently associated with hyponatremia. Here, we report the case of a 69-year-old man with non-Hodgkin's lymphoma who developed severe hyponatremia during chemotherapy. The Japanese man was diagnosed with diffuse large B-cell lymphoma, and underwent chemotherapy treatment with THP-COP(cyclophosphamide, pirarubicin, vincristine, and prednisolone). In the first course of chemotherapy, he developed hyponatremia(nadir 109 mEq/L)and his urinary N-acetyl-β-D-glucosaminidase(NAG)level had increased. After the second courses of chemotherapy with rituximab, pirarubicin, and prednisolone, without cyclophosphamide and vincristine, he had developed light hyponatremia(nadir 130 mEq/L). However, after the third and fourth courses of chemotherapy with rituximab, pirarubicin, prednisolone, and cyclophosphamide, he had developed a medium level of hyponatremia(nadir 124-125 mEq/L)and his NAG level had increased further. The possible mechanism of this phenomenon is due to renal tubular damage by cyclophosphamide. We conclude that extra caution is necessary if a patient develops severe hyponatremia following chemotherapeutic treatment with cyclophosphamide and vincristine.
要旨
cyclophosphamide(CPA)とvincristine(VCR)を含む化学療法中の合併症に低Na血症が知られている。今回,非ホジキンリンパ腫の化学療法中に重篤な低Na血症を呈した症例を経験した。症例は69歳,男性。びまん性大細胞型B細胞リンパ腫と病理診断され,THP-COP療法が開始された。第1コース中に血清109 mEq/Lの低Na血症を呈し,N-acetyl-β-D-glucosaminidase(NAG)の上昇を認めた。CPAとVCRを除いた第2コースでは血清Na濃度は130 mEq/Lにとどまった。第3コース以降にCPAを含めた化学療法を実施したところ血清Na濃度は124～125 mEq/Lまでの中等度の低下があり,NAGの上昇があった。CPAとVCRの併用療法による低Na血症の原因には,少なくともCPAによる腎尿細管障害があった。CPAとVCRの併用療法中に低Na血症を呈した患者で,その後化学療法を施行する際には低Na血症発現の注意喚起をする必要がある。
目次
Summary
Cyclophosphamide and vincristine are known to be the chemotherapeutic agents most frequently associated with hyponatremia. Here, we report the case of a 69-year-old man with non-Hodgkin's lymphoma who developed severe hyponatremia during chemotherapy. The Japanese man was diagnosed with diffuse large B-cell lymphoma, and underwent chemotherapy treatment with THP-COP(cyclophosphamide, pirarubicin, vincristine, and prednisolone). In the first course of chemotherapy, he developed hyponatremia(nadir 109 mEq/L)and his urinary N-acetyl-β-D-glucosaminidase(NAG)level had increased. After the second courses of chemotherapy with rituximab, pirarubicin, and prednisolone, without cyclophosphamide and vincristine, he had developed light hyponatremia(nadir 130 mEq/L). However, after the third and fourth courses of chemotherapy with rituximab, pirarubicin, prednisolone, and cyclophosphamide, he had developed a medium level of hyponatremia(nadir 124-125 mEq/L)and his NAG level had increased further. The possible mechanism of this phenomenon is due to renal tubular damage by cyclophosphamide. We conclude that extra caution is necessary if a patient develops severe hyponatremia following chemotherapeutic treatment with cyclophosphamide and vincristine.
要旨
cyclophosphamide(CPA)とvincristine(VCR)を含む化学療法中の合併症に低Na血症が知られている。今回,非ホジキンリンパ腫の化学療法中に重篤な低Na血症を呈した症例を経験した。症例は69歳,男性。びまん性大細胞型B細胞リンパ腫と病理診断され,THP-COP療法が開始された。第1コース中に血清109 mEq/Lの低Na血症を呈し,N-acetyl-β-D-glucosaminidase(NAG)の上昇を認めた。CPAとVCRを除いた第2コースでは血清Na濃度は130 mEq/Lにとどまった。第3コース以降にCPAを含めた化学療法を実施したところ血清Na濃度は124～125 mEq/Lまでの中等度の低下があり,NAGの上昇があった。CPAとVCRの併用療法による低Na血症の原因には,少なくともCPAによる腎尿細管障害があった。CPAとVCRの併用療法中に低Na血症を呈した患者で,その後化学療法を施行する際には低Na血症発現の注意喚起をする必要がある。