Lenalidomide
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Fanconi syndrome: case report A 62-year-old woman developed Fanconi syndrome during treatment with lenalidomide for multiple myeloma. The woman, who was on thiamazole for hyperthyroidism, presented to a nephrology clinic of a hospital with lethargy. Five months ago, she had been diagnosed with multiple myeloma. She had initially received two cycles of chemotherapy with bortezomib, lenalidomide [dosage and route not stated] and dexamethasone. Following the treatment, she had transient hypokalemia that had improved with replacement. A week before her current presentation, she had received third chemotherapy cycle of ixazomib, lenalidomide [dosage and route not stated] and dexamethasone. Her laboratory investigations were significant for severe hypokalemia, hypophosphatemia, hypomagnesemia, normoglycemic glucosuria and normal anion gap metabolic acidosis with a positive urine anion gap. Urine protein to creatinine ratio was 3.5 g/g and urine was acellular. She had severe acute tubular injury in both the proximal and distal tubules, while well-preserved proximal tubular epithelial cells had ample granular eosinophilic cytoplasm. Although immunohistochemistry showed kappa-restricted staining in some cells, immunofluorescence was negative for kappa light chains. Her electrolyte and acid–base abnormalities were consistent with Fanconi syndrome due to proximal tubulopathy, while her alkaline urine suggested impaired urine acidification by the distal tubule. Her pan-tubulopathy was consistent with histology showing severe acute tubular injury in both proximal and distal tubules. The woman’s condition improved with electrolyte replacement and she subsequently received chemotherapy with bortezomib, cyclophosphamide and dexamethasone without recurrence of acidosis or electrolyte derangements. Lim CC, et al. An unusual cause of renal tubular dysfunction in multiple myeloma. International Urology and Nephrology 52: 1603-1605, No. 8, Aug 2020. Available from: URL: http://doi.org/10.1007/s11255-020-02504-z 803498388
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Reactions 29 Aug 2020 No. 1819
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