Erlotinib
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Erlotinib Renal function deterioration secondary to tubulointerstitial nephritis: case report
A 71-year-old man developed renal function deterioration secondary to tubulointerstitial nephritis during treatment with erlotinib for lung adenocarcinoma. The man was admitted for renal function deterioration. He was diagnosed of stage IV epidermal growth factor receptor mutated lung adenocarcinoma 6 months previously. He had been receiving erlotinib 150mg daily [route not stated] with partial response. Five and seven weeks following the erlotinib administration, his serum creatinine (SCr) elevated to 1.7 mg/dL and 2.2 mg/dL, respectively. Prior to erlotinib initiation, the SCr was 0.9 mg/dL. His medical history was significant for diabetes mellitus and hypertension. His concomitant medication included metformin, nifedipine and linagliptin. Physical exam revealed a BP of 164/83mm Hg and chronic xerotic eczema. Laboratory findings were significant for hypomagnaesemia. Urine sediments demonstrated sterile leucocyturia. A urine protein-to creatinine ratio was found to be 236 mg/g. Ultrasound revealed kidneys of normal size with increased echogenicity. The renal biopsy showed tubulointerstitial nephritis and focal chronicity with mild interstitial fibrosis. The glomeruli (26 observed, 1 obsolete) revealed only mild mesangial hypercellularity and matrix expansion. The tubules showed focal destruction with some microabscess composed of inflammatory cells in tubular lumens. The interstitium disclosed mildly mixed lymphocytes and eosinophils infiltration. Periodic acid-Schiff stain showed mild tubular atrophy. Masson trichrome stain showed mild interstitial fibrosis. The Naranjo Score was 7 suggesting the probable relationship between erlotinib and tubulointerstitial nephritis [duration of treatment to reaction onset not stated]. The man was treated with prednisolone and erlotinib was stopped. After 4 months, the SCr dropped to 1.6 mg/dL. Follow-up urinalysis showed the disappearance of leucocyturia. Subsequently, his treatment was switched to gefitinib. Thereafter, his SCr remained stable at 1.7 mg/dL. Cho S-L, et al. Tubulointerstitial nephritis associated with erlotinib therapy for lung cancer. Nephrology 25: 730, No. 9, Sep 2020. Available from: URL: http:// doi.org/10.1111/nep.13721
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