Acute Renal Failure in the Setting of “Low-Risk” Therapy for Mesothelioma

Abstract

References Conclusion A 77 year-old male with a history of asbestos exposure and malignant mesothelioma was transferred from an outside hospital after presenting with pleuritic pain and acute on chronic renal failure with a creatinine of 10.01. • Mesothelioma was diagnosed one year prior. At diagnosis, he declined aggressive chemotherapy due to risk of toxicity and opted for high dose Vitamin C infusion with nutritional therapy. • The patient was critically ill on presentation with a severe anion gap metabolic acidosis with underlying metabolic alkalosis. His creatinine was 10.01 (baseline one month prior 1.97) and BUN was 104. • The etiology of the patient’s acute onset of renal failure was initially unclear, and a diagnostic workup ensued. •Urine electrolyte analysis was consistent with an intrinsic pathology. •Microscopic evaluation revealed oxalate crystals (example shown on Figure 1). •Ultrasound with bilateral calculi and increased echogenicity was consistent with oxalate deposition. (Figure 2) • These findings were consistent with high dose Vitamin C toxicity as no alternative ingestion causing oxalate crystals was identified. • Unfortunately, his clinical situation deteriorated over the hospital course. A CT of the chest revealed progressive mesothelioma, and his renal failure was irreversible. Hypoxic respiratory failure secondary to hypervolemia resulted. The patient declined dialysis and switched his goals to pure palliation.