Nintedanib-induced glomerular microangiopathy: a case report

  • PDF / 1,178,652 Bytes
  • 6 Pages / 595.276 x 790.866 pts Page_size
  • 101 Downloads / 199 Views

DOWNLOAD

REPORT


CASE REPORT

Nintedanib‑induced glomerular microangiopathy: a case report Masataka Hasegawa1 · Atsuko Uehara1 · Tomo Suzuki1,2 · Reio Sekine3 · Masahiko Yazawa1 · Daisuke Ichikawa1 · Junki Koike4 · Yugo Shibagaki1 Received: 6 December 2019 / Accepted: 2 April 2020 © Japanese Society of Nephrology 2020

Abstract Nintedanib, a triple tyrosine kinase inhibitor of vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and fibroblast growth factor receptor, has been used in idiopathic pulmonary fibrosis and adenocarcinoma in advanced non-small cell lung cancer. Although vascular endothelial growth factor inhibitors have been reported to cause endothelial injury and glomerular microangiopathy, nintedanib-induced glomerular microangiopathy has not been reported. A 68-year-old man with a history of primary aldosteronism, idiopathic pulmonary fibrosis, and pleomorphic carcinoma of the lung developed proteinuria and leg edema after nintedanib initiation. Kidney biopsy revealed prominent endothelial and mesangial injury. Proteinuria improved after nintedanib withdrawal. To the best of our knowledge, this is the second case report of nintedanib-induced glomerular microangiopathy. Although the incidence of nephropathy among patients receiving nintedanib is unknown at this moment, we recommend monitoring urinary protein excretion and blood pressure in patients receiving nintedanib and performing kidney biopsy to determine any histopathological change. Keywords  Nintedanib · Glomerular microangiopathy · Proteinuria · Pulmonary fibrosis · Onconephrology

Introduction Inhibiting tumor angiogenesis mediated by vascular endothelial growth factor (VEGF) has become a main stream in current cancer treatment. With the expanding use of VEGF inhibitors, their nephrotoxicity causing endothelial injury and glomerular microangiopathy has been reported [1]. Nintedanib, a triple tyrosine kinase inhibitor of VEGF receptor, platelet-derived growth factor (PDGF) receptor, and fibroblast growth factor (FGF) receptor, has been used in idiopathic pulmonary fibrosis and adenocarcinoma in

* Atsuko Uehara [email protected] 1



Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2‑16‑1, Sugao, Miyamae‑ku, Kawasaki, Kanagawa 216‑8511, Japan

2



Department of Nephrology, Kameda Medical Center, Chiba, Japan

3

Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

4

Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan



advanced non-small cell lung cancer, offering substantial benefit [2–4]. Although nintedanib also inhibits VEGF signaling pathway, there have been no reports on endothelial injury and glomerular microangiopathy [1]. We herein report a patient with pulmonary fibrosis who developed proteinuria due to nintedanib-induced glomerular microangiopathy, which has been rarely reported.

Case presentation A 68-year-old man with a history of primary aldoste