title: Rhabdomyolysis-induced acute kidney injury in a cancer patient exposed to denosumab and abiraterone: a case report.
abstract: BACKGROUND
  Denosumab and abiraterone were approved by the United States Food and Drug Administration in 2011 for the treatment of metastatic castration-resistant prostate cancer. Neither denosumab nor abiraterone is known to cause rhabdomyolysis.
  
  
  METHODS
  A 76-year-old Caucasian man with metastatic prostate cancer presented with non-oliguric severe acute kidney injury (AKI) 3 weeks after receiving simultaneous therapy with denosumab and abiraterone. The patient had been on statin therapy for more than 1 year with no recent dose adjustments. His physical exam was unremarkable. Blood work on admission revealed hyperkalemia, mild metabolic acidosis, hypocalcemia, and elevated creatine kinase (CK) at 44,476 IU/L. Kidney biopsy confirmed the diagnosis of rhabdomyolysis-induced AKI. The patient responded well to intravenous isotonic fluids and discontinuation of denosumab, abiraterone, and rosuvastatin, with normalization of CK and recovery of kidney function.
  
  
  CONCLUSIONS
  We report the first case of biopsy-proven rhabdomyolysis-induced AKI in a cancer patient acutely exposed to denosumab and abiraterone. Whether one of these drugs individually, or the combination, was the bona fide culprit of muscle breakdown is unknown. Nonetheless, our report is hypothesis-generating for further investigations on the effect of these drugs on muscle cells.
authors.affiliation: Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8516, USA. Javier.NeyraLozano@UTSouthwestern.edu.|Division of Nephrology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8516, USA. Javier.NeyraLozano@UTSouthwestern.edu.
authors.forename: Javier A
authors.initials: JA
authors.lastname: Neyra
authors.affiliation: Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8516, USA. natalia.dealbuquerquerocha@phhs.org.
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Rocha
authors.affiliation: Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA. bhargavar@umkc.edu.
authors.forename: Rhea
authors.initials: R
authors.lastname: Bhargava
authors.affiliation: Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA. ovaidya@yahoo.com.|Division of Nephrology, University of Missouri-Kansas City, Kansas City, Missouri, USA. ovaidya@yahoo.com.
authors.forename: Omkar U
authors.initials: OU
authors.lastname: Vaidya
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8516, USA. allen.hendricks@UTSouthwestern.edu.
authors.forename: Allen R
authors.initials: AR
authors.lastname: Hendricks
authors.affiliation: Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8516, USA. aylin.rodan@UTSouthwestern.edu.|Division of Nephrology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8516, USA. aylin.rodan@UTSouthwestern.edu.
authors.forename: Aylin R
authors.initials: AR
authors.lastname: Rodan
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D000736:Androstenes / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000069448:Denosumab / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000473:pathology; D012206:Rhabdomyolysis / Q000150:complications*; D000068718:Rosuvastatin Calcium / Q000627:therapeutic use
chemical_list: D000736:Androstenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069448:Denosumab; D000068718:Rosuvastatin Calcium; C089740:abiraterone