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Worsening membranous nephropathy in a patient with GIST treated with sunitinib
- Source :
- BMJ case reports. 14(8)
- Publication Year :
- 2023
-
Abstract
- Tyrosine kinase inhibitors (TKI) are anticancer agents widely used for a variety of malignancies including gastrointestinal stromal tumours (GIST). Although generally well-tolerated, TKIs have been associated with a number of adverse events including hypertension, proteinuria and nephrotic syndrome. We present the case of a 70-year-old patient with metastatic GIST on long-standing sunitinib who developed hypertension, oedema and hypoalbuminemia with a rising serum creatinine and was found to have nephrotic syndrome. Workup revealed elevated antiphospholipase A2 receptor (PLA2R) antibody IgG titres and a kidney biopsy confirmed PLA2R-positive membranous nephropathy without findings of thrombotic microangiopathy. Cessation of sunitinib led to reduction in anti-PLA2R antibody IgG titres while resumption, due to concern for cancer progression, led to worsening symptoms. Treatment with rituximab led to undetectable anti-PLA2R IgG titres. We highlight the importance of maintaining a systematic approach for evaluating nephrotic syndrome and provide a case showing that TKIs can exacerbate underlying nephrotic syndrome.
- Subjects :
- medicine.medical_specialty
Thrombotic microangiopathy
Proteinuria
Nephrotic Syndrome
GiST
Sunitinib
business.industry
Gastrointestinal Stromal Tumors
General Medicine
medicine.disease
Gastroenterology
Glomerulonephritis, Membranous
Membranous nephropathy
Internal medicine
medicine
Humans
Rituximab
Hypoalbuminemia
medicine.symptom
business
Nephrotic syndrome
medicine.drug
Aged
Autoantibodies
Subjects
Details
- ISSN :
- 1757790X
- Volume :
- 14
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- BMJ case reports
- Accession number :
- edsair.doi.dedup.....7ef1cd4611ab1f16dbae5994b3b7eacb