Nintedanib-Induced Renal Thrombotic Microangiopathy
Nintedanib is a unique tyrosine kinase inhibitor used to suppress fibrosis in patients with idiopathic pulmonary fibrosis (IPF). Nintedanib has been shown to suppress multiple processes of fibrosis, thereby reducing the rate of lung function decline in patients with IPF. Since vascular endothelial g...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2021-07-01
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| Series: | Case Reports in Nephrology and Dialysis |
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| Online Access: | https://www.karger.com/Article/FullText/517692 |
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| author | Takeshi Fujita Hideyuki Nakagawa Takashi Yokota Jun Umetani Daiki Nagawa Masamichi Nakata Ikuyo Narita-Kinjo Reiichi Murakami Michiko Shimada Norio Nakamura Hirofumi Tomita |
| author_facet | Takeshi Fujita Hideyuki Nakagawa Takashi Yokota Jun Umetani Daiki Nagawa Masamichi Nakata Ikuyo Narita-Kinjo Reiichi Murakami Michiko Shimada Norio Nakamura Hirofumi Tomita |
| author_sort | Takeshi Fujita |
| collection | DOAJ |
| description | Nintedanib is a unique tyrosine kinase inhibitor used to suppress fibrosis in patients with idiopathic pulmonary fibrosis (IPF). Nintedanib has been shown to suppress multiple processes of fibrosis, thereby reducing the rate of lung function decline in patients with IPF. Since vascular endothelial growth factor is one of this agent’s targets, nephrotoxicity, including renal thrombotic microangiopathy (TMA), is a possible major adverse effect. However, only 2 previous cases of nintedanib-induced renal TMA have been published. Our patient was an 83-year-old man with IPF. As adverse effects including liver enzyme level elevation, diarrhoea, anorexia, and nephrotoxicity developed, the nintedanib dosage was reduced after 9 months. The digestive symptoms resolved promptly, but the proteinuria and reduced kidney function remained. Although the kidney injury had improved to some extent, we performed a percutaneous renal biopsy. The biopsy revealed typical TMA findings such as microaneurysms filled with pale material, segmental double contours of glomerular basement membranes, and intracapillary foam cells. After discontinuation of nintedanib, the patient’s nephrotoxicity improved. Nintedanib-induced renal TMA is reversible and is possibly dose-dependent. Here, we report the clinical course of our case and review the characteristics of nintedanib-induced renal TMA. |
| first_indexed | 2024-12-22T16:03:22Z |
| format | Article |
| id | doaj.art-1b1b74cdc7c340ea831c2cb159b62d7e |
| institution | Directory Open Access Journal |
| issn | 2296-9705 |
| language | English |
| last_indexed | 2024-12-22T16:03:22Z |
| publishDate | 2021-07-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Nephrology and Dialysis |
| spelling | doaj.art-1b1b74cdc7c340ea831c2cb159b62d7e2022-12-21T18:20:39ZengKarger PublishersCase Reports in Nephrology and Dialysis2296-97052021-07-0111222723210.1159/000517692517692Nintedanib-Induced Renal Thrombotic MicroangiopathyTakeshi Fujita0Hideyuki Nakagawa1Takashi Yokota2Jun Umetani3Daiki Nagawa4Masamichi Nakata5Ikuyo Narita-Kinjo6Reiichi Murakami7Michiko Shimada8Norio Nakamura9Hirofumi Tomita10Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanRespiratory Medicine, Hirosaki National Hospital, Hirosaki, Aomori, JapanCardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanNintedanib is a unique tyrosine kinase inhibitor used to suppress fibrosis in patients with idiopathic pulmonary fibrosis (IPF). Nintedanib has been shown to suppress multiple processes of fibrosis, thereby reducing the rate of lung function decline in patients with IPF. Since vascular endothelial growth factor is one of this agent’s targets, nephrotoxicity, including renal thrombotic microangiopathy (TMA), is a possible major adverse effect. However, only 2 previous cases of nintedanib-induced renal TMA have been published. Our patient was an 83-year-old man with IPF. As adverse effects including liver enzyme level elevation, diarrhoea, anorexia, and nephrotoxicity developed, the nintedanib dosage was reduced after 9 months. The digestive symptoms resolved promptly, but the proteinuria and reduced kidney function remained. Although the kidney injury had improved to some extent, we performed a percutaneous renal biopsy. The biopsy revealed typical TMA findings such as microaneurysms filled with pale material, segmental double contours of glomerular basement membranes, and intracapillary foam cells. After discontinuation of nintedanib, the patient’s nephrotoxicity improved. Nintedanib-induced renal TMA is reversible and is possibly dose-dependent. Here, we report the clinical course of our case and review the characteristics of nintedanib-induced renal TMA.https://www.karger.com/Article/FullText/517692drug-induced kidney injuryidiopathic pulmonary fibrosisnephrotic syndromenintedanibproteinuriathrombotic microangiopathytyrosine kinase inhibitor |
| spellingShingle | Takeshi Fujita Hideyuki Nakagawa Takashi Yokota Jun Umetani Daiki Nagawa Masamichi Nakata Ikuyo Narita-Kinjo Reiichi Murakami Michiko Shimada Norio Nakamura Hirofumi Tomita Nintedanib-Induced Renal Thrombotic Microangiopathy Case Reports in Nephrology and Dialysis drug-induced kidney injury idiopathic pulmonary fibrosis nephrotic syndrome nintedanib proteinuria thrombotic microangiopathy tyrosine kinase inhibitor |
| title | Nintedanib-Induced Renal Thrombotic Microangiopathy |
| title_full | Nintedanib-Induced Renal Thrombotic Microangiopathy |
| title_fullStr | Nintedanib-Induced Renal Thrombotic Microangiopathy |
| title_full_unstemmed | Nintedanib-Induced Renal Thrombotic Microangiopathy |
| title_short | Nintedanib-Induced Renal Thrombotic Microangiopathy |
| title_sort | nintedanib induced renal thrombotic microangiopathy |
| topic | drug-induced kidney injury idiopathic pulmonary fibrosis nephrotic syndrome nintedanib proteinuria thrombotic microangiopathy tyrosine kinase inhibitor |
| url | https://www.karger.com/Article/FullText/517692 |
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