Goździk Maciej, Płuciennik Agnieszka, Zawiasa-Bryszewska Anna, Nowicka Maja, Nowicka Zuzanna, Wągrowska-Danilewicz Małgorzata, Kurnatowska Ilona
Department of Clinical Pharmacology, 1st Chair of Internal Medicine, Medical University of Łódź, ul. Kopcińskiego 22, 90-153, Lodz, Poland.
Department of Nephrology, Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland.
Drug Saf Case Rep. 2019 Oct 5;6(1):9. doi: 10.1007/s40800-019-0103-x.
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in non-diabetic adult patients; 75% of adult patients with MN suffer from primary idiopathic membranous nephropathy (IMN). The treatment of choice is immunosuppressive therapy, with a combination of steroids and cyclophosphamide (CYF) or chlorambucil or, as second-line treatment, calcineurin inhibitors (CNIs). One of the main concerns associated with the usage of CNIs is their potential to induce nephrotoxicity. We report a case of acute kidney injury that developed on two separate occasions within days of the administration of CNIs in a 57-year-old male patient treated for MN. The patient was qualified for first-line treatment with prednisone and CYF. Due to insufficient response and bad tolerance of CYF infusions, the immunosuppressive regimen was modified and CNIs were introduced, starting with cyclosporine A (CsA). On the third day of treatment, a severe decrease in diuresis and kidney function occurred and CsA was discontinued, resulting in a return to baseline kidney function. After 2 months, the situation repeated after attempting to introduce tacrolimus.
膜性肾病（MN）是非糖尿病成年患者肾病综合征最常见的病因之一；75%的成年MN患者患有原发性特发性膜性肾病（IMN）。首选治疗方法是免疫抑制治疗，联合使用类固醇和环磷酰胺（CYF）或苯丁酸氮芥，或者作为二线治疗使用钙调神经磷酸酶抑制剂（CNIs）。与使用CNIs相关的主要问题之一是其诱发肾毒性的可能性。我们报告了一例57岁男性MN患者在接受CNIs治疗数天内两次出现急性肾损伤的病例。该患者符合泼尼松和CYF一线治疗的条件。由于对CYF输注反应不足且耐受性差，免疫抑制方案进行了调整并引入了CNIs，从环孢素A（CsA）开始。治疗第三天，尿量和肾功能严重下降，CsA停药，肾功能恢复至基线水平。2个月后，尝试引入他克莫司后情况再次出现。
