Khurana Anand
Scott & White Memorial Hospital and Clinic, Texas A&M College of Health Sciences Center, Temple, Texas 76508, USA.
Am J Geriatr Pharmacother. 2007 Dec;5(4):341-4. doi: 10.1016/j.amjopharm.2007.12.011.
Sunitinib is an oral multitargeted inhibitor indicated for the treatment of renal cell carcinoma.
This report describes a case of allergic interstitial nephritis possibly related to this agent.
A 69-year-old female patient with a history of metastatic renal cell carcinoma after left radical nephrectomy presented to our nephrology clinic after completing 2 courses of sunitinib therapy. The patient was noted to have progressive kidney dysfunction with proteinuria, together with peripheral eosinophilia and eosinophiluria, which developed during the first of 2 cycles of sunitinib therapy. Her concomitant medications included atenolol, triamterene/hydrochlorothiazide, amlodipine, and multivitamin tablets, all of which she had been receiving at stable doses over the previous 2 years. There were no other over-the-counter medications involved and other possible causes of interstitial nephritis were excluded. The proteinuria, eosinophilia, and eosinophiluria worsened with the second course and resolved after sunitinib discontinuation, which resulted in initial stabilization followed by slight improvement in kidney function. The Naranjo Adverse Drug Reaction Probability Scale score for this event was 7, indicating a probable association of the event with the drug. With clinical improvement after discontinuation of sunitinib and the presence of a solitary remaining kidney and thrombocytopenia, renal biopsy was not performed after discussion with the patient. When challenged with a related agent, sorafenib, the patient experienced worsening of serum creatinine and increasing eosinophilia, similar to that noted with sunitinib, suggesting that this event may be a class effect.
Nephrologists and oncologists should be aware of allergic interstitial nephritis as an adverse effect related to this agent. Although there are no current recommendations for monitoring serum creatinine with sunitinib therapy, we recommend that serum creatinine and white cell count with differential be checked within 2 weeks of initiation of therapy with sunitinib to enable earlier diagnosis of this condition and avoid renal damage.
舒尼替尼是一种口服多靶点抑制剂，用于治疗肾细胞癌。
本报告描述了1例可能与此药相关的过敏性间质性肾炎病例。
一名69岁女性患者，有左侧根治性肾切除术后转移性肾细胞癌病史，在完成2个疗程舒尼替尼治疗后到我们肾内科门诊就诊。该患者在舒尼替尼治疗的2个周期中的第1个周期出现进行性肾功能不全伴蛋白尿，同时伴有外周血嗜酸性粒细胞增多和嗜酸性粒细胞尿。她同时服用的药物包括阿替洛尔、氨苯蝶啶/氢氯噻嗪、氨氯地平和多种维生素片，在过去2年中她一直以稳定剂量服用这些药物。未涉及其他非处方药，且排除了间质性肾炎的其他可能病因。蛋白尿、嗜酸性粒细胞增多和嗜酸性粒细胞尿在第2个疗程时加重，停用舒尼替尼后缓解，肾功能最初稳定，随后略有改善。该事件的Naranjo药物不良反应概率量表评分为7分，表明该事件可能与药物有关。由于停用舒尼替尼后临床症状改善，且患者仅存1个肾脏并有血小板减少症，与患者讨论后未进行肾活检。当使用相关药物索拉非尼进行激发试验时，患者血清肌酐恶化，嗜酸性粒细胞增多，与舒尼替尼治疗时情况相似，提示该事件可能是类效应。
肾内科医生和肿瘤内科医生应意识到过敏性间质性肾炎是与此药相关的一种不良反应。虽然目前对于舒尼替尼治疗时监测血清肌酐尚无推荐，但我们建议在开始舒尼替尼治疗后2周内检查血清肌酐和白细胞分类计数，以便更早诊断此病并避免肾损害。
