TCbHP consists of Docetaxel, Carboplatin, Pertuzumab and Trastuzumab. Carboplatin, a new AnAlogue of cisplatin used in the treatment of breast carcinoma, is the second generation platinum compound, which has been certificated to have less nephrotoxic than cisplatin. The major side effects of Carboplatin are myelosupression and gastrointestinal effects. Nephrotoxicity, neurotoxicity, hematotoxicity, anaphylactic reaction can also be seen.
Firstly, no matter in clinical research or in the researches carried out in the laboratory, there are many reports about the impairment of kidney function even acute renal failure caused by carboplatin[[4–8], which is rare in adverse reactions of the remaining three drugs. Secondly, in the process of recording the medical history, the patient denied the history of diabete, but blood glucose monitoring shows the patient may have diabete(Table 1), which may blow up the drug damage to the kidney at a reasonable dose.So we consider that there is the acute kidney injury happened to this patient owing to Carboplatin.
Many experiments show that the metabolism of Carboplatin mainly depends on the kidney, but how Carboplatin causes nephrotoxicity is not fully revealed, which is believed to be owing to both direct and indirect damage to the kidneys including drug absorption and transport, oxidative stress of renal proximal tubule epithelial cells, apoptosis and inflammatory response[10–12]. However, because of the lower nephrotoxicity than Cisplatin, acute kidney injury(AKI) caused by Carboplatin, including acute tubular necrosis can not be seen often.
Normally, according to the location and cause of the disease, AKI can be divided into three categories: Prerenal AKI, Renal AKI, Postrenal AKI. Acute kidney injury caused by drug factors may be the main reason of this case. There are three cases reported to be proved acute interstitial nephritis (AIN) by performing a percutaneous renal biopsy[5, 13]. In this case, we focused on the treatment of the condition instead of judgment of the lesion, so we did not perform analogous biopsy to establish an accurate diagnosis.
In order to prevent and handle this emergency situations, we can choose both conventional medication or treatment and traditional chinese medicine treatment and nursing. On one hand, we can use pentoxifylline-non-specific phosphodiesterase inhibitor or pravastatin as adjuvant drugs[13–15]or giving plenty of water、adding magnesium to reduce kidney damage[16, 17], and if AKI has happened, we should remove the cause、correct electrolyte imbalance or choose symptomatic drugs even alternative therapy. On the other hand, traditional chinese medicine treatment and nursing can also be useful. For example, according to the traditional Chinese medicine“look, smell, ask and cut”on physique screening and judgment, individual guidance for life and health can be carried on to protect kidney. Medicina diet is also suitable for patients to regulate the physique. For example, astragalus carp soup can invigorate the spleen, nourish qi and yin, dispel dampness, promote diuresis, and increase the growth of qi and blood. Carp, adzuki bean, lotus seeds, ginger and other medicines and foods are homologous, so it is safe and effective with long-term consumptio. At the same time, acupuncture point massage at Neiguan point、Laogong point、Guanyuan point、Shenshu point can be good choice for patients, we can choose Shuifen point、Yanglingquan point、Jianli point as an assistant in edema period. For the low creatinine clearance, retention enema with Serissa foetida Comn、Rheum officinale、Coptic and Scutellaria baicalensis will be beneficial.
Chemotherapy-related nausea and vomiting(CINV)is the most common adverse reactions of Carboplatin, which is one of the middle-to-high grade emetic chemotherapeutic drugs. When the area under the curve is less than 4, the incidence of CINV is 65%.Diarrhea is also one of the common adverse reactions of Carboplatin-Docetaxel combination. At the same time, AKI can also been seen nausea, vomiting and diarrhea as its first symptoms. Currently, serotonin receptor antagonists like Tropisetron,Ondansetron,and Granisetron is common and the symptomatic treatment of Traditional Chinese medicine treatment is superior to western medicine in some occasions when it comes to treatment,such as Shenque acupoint can be selected in acupoint sticking therapy with a mixture of cornus officinails, cumin and ginger juice once a day, the yang deficiency patients can be treated with moxibustion three strong every time[25, 26].
Taking the side effects of these drugs the patient used into consideration[27–31], the symptoms of acute pancreatitis the patient had is more relevant to irregular diet and history of gallbladder stones.
The key reason why chemotherapeutics can treat tumor diseases is that they can inhibit the proliferation of cancer cells and use drugs to inhibit the division of cancer cells. Because chemotherapy drugs are often used systemically, the oral mucosa with similar proliferation characteristics of tumor cells is the first to be attacked.The reduced immunity the chemotherapeutics caused, and the reduced barrier function on account of the damage of Oral mucosa cells, which are both in favor of the bacteria or fungi infection.
When we discuss the cause of these symptoms, we should take the drugs the patient used and the histories into consideration.