Abstract: SA-PO280
Dasatinib-Associated FSGS: A Case Report
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Loi, Valentina, Ospedale Brotzu, Cagliari, Italy
- Lepori, Nicola, Ospedale Brotzu, Cagliari, Italy
- Floris, Matteo, Ospedale Brotzu, Cagliari, Italy
- Asunis, Anna Maria, Ospedale Brotzu, Cagliari, Italy
- Angioi, Andrea, Ospedale Brotzu, Cagliari, Italy
- Cao, Riccardo, Ospedale Brotzu, Cagliari, Italy
- Atzeni, Alice, Ospedale Brotzu, Cagliari, Italy
- Piras, Doloretta, Ospedale Brotzu, Cagliari, Italy
- Cabiddu, Gianfranca, Ospedale Brotzu, Cagliari, Italy
- Pani, Antonello, Ospedale Brotzu, Cagliari, Italy
Introduction
Renal adverse effects associated with the use of TKI include arterial hypertension, proteinuria, acute kidney injury (AKI), and thrombotic microangiopathy (TMA); however there are only a few reports of TKI-associated nephrotic syndrome
Case Description
A 69 y/o woman was diagnosed in June 2016 with Philadelphia chromosome-positive chronic myeloid leukaemia for which she was initially treated with hydroxyurea 1.5 g/day for 2 weeks and then with Dasatinib100 mg/day achieving complete remission. Her past medical history included arterial hypertension, type 2 diabetes mellitus and dyslipidaemia. Her previous kidney function was normal and she had no proteinuria. After 8 months on Dasatinib, , the patient developed a progressive and rapid worsening of her kidney function (sCr from 0.76 to 2.2mg/dL) associated with the onset of a nephrotic syndrome with proteinuria up to 6g/24h, hypoalbuminemia (serum albumin 2.4g/dL), lower extremity pitting oedema and mild pleural and pericardial effusion. Blood cell count showed a mild anaemia; ANA, ANCA, HBV and HCV markers, complement were normal. In consideration of this clinical picture, the drug dose was reduced to 100mg every other day. Over the next few months her kidney function remained stable with sCr of 1.7mg/dL, proteinuria of 3.5g/24h, serum albumin of 2.9g/dL, total cholesterol level of 297mg/dL. In October 2017 the patient underwent a kidney biopsy. Light microscopy showed glomeruli with segmental collapse of the tuft with concomitant pseudo-crescents. A mild mesangial expansion with a limited cellular proliferation was diffusely observed. Of interest, endothelial cells showed swollen cytoplasm with evident nuclei, suggestive of a diffuse endothelial injury. Tubuli, interstitium and vessels were unremarkable. IF was unremarkable. The patient was started on prednisone (0,5 mg/Kg/die) and Dasatinib was discontinued. After 6 months of treatment, proteinuria improved to 2,2g/24 hours, albuminemia raised to 3.5 g/dl and sCr improved to 1.5 mg/dl
Discussion
The improvement in proteinuria and albuminemia after cessation of Dasatinib and steroid treatment strongly imply this association between the nephritic syndrome and the treatment. This is, to our knowledge, the first case of focal segmental glomerulosclerosis secondary to Dasatinib treatment in an adult patient