Rapidly progressive glomerulonephritis caused by tegafur/gimeracil/oteracil resulted in diabetes nephropathy, in a patie
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CASE REPORT
Rapidly progressive glomerulonephritis caused by tegafur/gimeracil/ oteracil resulted in diabetes nephropathy, in a patient with minor risk of diabetes nephropathy: a case report Naoya Toriu1 · Naoki Sawa1 · Aya Imafuku1 · Eiko Hasegawa1 · Akinari Sekine1 · Hiroki Mizuno1 · Masayuki Yamanouchi1 · Rikako Hiramatsu1 · Noriko Hayami1 · Junichi Hoshino1 · Masahiro Kawada1 · Tatsuya Suwabe1 · Kenichi Ohashi2,4 · Takeshi Fujii2 · Yoshifumi Ubara1,3 Received: 14 January 2020 / Accepted: 23 April 2020 © Japanese Society of Nephrology 2020
Abstract A 79-year-old Japanese male with a history of type 2 diabetes mellitus (T2DM) for 16 years was admitted to evaluate possible renal disease. The T2DM was well controlled in this patient using nutrition therapy without the need for any diabetes medication, and both diabetes retinopathy and proteinuria were negative. At the age of 78 advanced colorectal cancer (stage IIIa) was diagnosed and laparoscopic-assisted colectomy was performed. Following this procedure, the patient began treatment with tegafur/gimeracil/oteracil (S-1), 80 mg twice daily for 28 days of 42-day cycle. The patient received S-1 for 6 months, during which time, serum albumin decreased from 3.0 g/dL to 1.1 g/dL, urinary protein increased from negative to 3.0 g/ day, and serum creatinine increased from 0.9 mg/dL to 2.1 mg/dL. Treatment with S-1 was discontinued, and furosemide 180 mg and prednisolone 30 mg treatment was initiated; however, serum creatinine levels continued to increase to 7.2 mg/ dL and proteinuria continued to increase reaching a nephrotic range. A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) activity was decreased to 27.0%. Renal biopsy showed Kimmelstiel–Wilson nodules, while immunofluorescence intensity of IgG subclass was IgG1 dominant, which was not compatible with diabetic nephropathy (DN). Plasma exchange was not affected. However, hemodialysis was initiated. The results of this investigation suggest that when S-1 monotherapy is performed in the case with DN, rapidly progressive glomerulonephritis (RPGN) may develop due to a condition similar to thrombotic microangiopathy, even in patients with a minor risk factor of DN. Keywords Colorectal cancer · Diabetes glomerulopathy · Nephropathy · S-1 · Thrombotic microangiopathy
* Naoya Toriu [email protected]‑u.ac.jp * Yoshifumi Ubara [email protected] 1
Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1‑3‑1, Takatsu, Kawasaki, Kanagawa 212‑0015, Japan
2
Department of Pathology, Toranomon Hospital, Tokyo, Japan
3
Okinaka Memorial Institute for Medical Research, Tokyo, Japan
4
Department of Pathology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
Abbreviations T2DM Type 2 diabetes mellitus ADAMTS13 A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 RPGN Rapidly progressive glomerulonephritis TMA Thrombotic microangiopathy anti-VEGF Anti-vascular endothelial growth factor S-1
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