SHM Converge Scientific Abstract ePoster Gallery-The Power of Inquiry: From Aki to Fanconi Syndrome

Pdf Summary

This case highlights how clinical curiosity can improve diagnosis. A 50-year-old man with chronic kidney disease and metastatic synovial sarcoma was admitted with nausea, vomiting, and acute kidney injury after his second cycle of doxorubicin, ifosfamide, and mesna. Because post-chemotherapy vomiting commonly causes pre-renal AKI, the initial impression fit that framework: he appeared volume depleted, and he was treated with antiemetics, IV fluids, and bicarbonate.<br /><br />However, a phase 1 medical student asked why the presentation did not fully match the expected pattern. That question prompted a diagnostic pause, broadening the differential and adding phosphorous and uric acid to the workup. The added labs showed hypophosphatemia, hypouricemia, glycosuria, proteinuria, and other findings consistent with Fanconi syndrome, a proximal tubular disorder. The syndrome was likely caused by ifosfamide.<br /><br />The patient’s creatinine improved more slowly than expected, leading to early specialist involvement and discontinuation of ifosfamide. He was continued on single-agent doxorubicin, with a new creatinine baseline of 1.6.<br /><br />The case emphasizes that cognitive biases such as anchoring, availability, and overconfidence can influence diagnostic reasoning. A deliberate diagnostic pause and willingness to question an assumed diagnosis helped identify a rare but important chemotherapy complication earlier, improving care and preventing further renal injury.

Asset Subtitle

Anthony Dao

Meta Tag

Author List Anthony Dao

Category Clinical Vignettes

Concept Prerenal Acute Kidney Injury

Concept Ifosfamide

Concept Fanconi Syndrome

Concept Diagnostic Pause

Concept Proximal Tubular Defect

Distinguished Non-Finalist

Presenter Organization Washington University School of Medicine

Presenting Author Anthony Dao

Track Adult

Keywords

Fanconi syndrome

ifosfamide

acute kidney injury

chemotherapy complication

proximal tubular disorder

hypophosphatemia

hypouricemia

glycosuria

diagnostic reasoning

cognitive bias

Prerenal Acute Kidney Injury

Ifosfamide

Fanconi Syndrome

Diagnostic Pause

Proximal Tubular Defect