Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Department of Nephrology, Kameda Medical Center, Chiba, Japan.
CEN Case Rep. 2020 Nov;9(4):295-300. doi: 10.1007/s13730-020-00474-w. Epub 2020 Apr 11.
Nintedanib, a triple tyrosine kinase inhibitor of vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and fibroblast growth factor receptor, has been used in idiopathic pulmonary fibrosis and adenocarcinoma in advanced non-small cell lung cancer. Although vascular endothelial growth factor inhibitors have been reported to cause endothelial injury and glomerular microangiopathy, nintedanib-induced glomerular microangiopathy has not been reported. A 68-year-old man with a history of primary aldosteronism, idiopathic pulmonary fibrosis, and pleomorphic carcinoma of the lung developed proteinuria and leg edema after nintedanib initiation. Kidney biopsy revealed prominent endothelial and mesangial injury. Proteinuria improved after nintedanib withdrawal. To the best of our knowledge, this is the second case report of nintedanib-induced glomerular microangiopathy. Although the incidence of nephropathy among patients receiving nintedanib is unknown at this moment, we recommend monitoring urinary protein excretion and blood pressure in patients receiving nintedanib and performing kidney biopsy to determine any histopathological change.
尼达尼布是一种血管内皮生长因子受体、血小板衍生生长因子受体和成纤维细胞生长因子受体的三酪氨酸激酶抑制剂，已用于特发性肺纤维化和晚期非小细胞肺癌中的腺癌。尽管已经报道血管内皮生长因子抑制剂会引起内皮损伤和肾小球微血管病变，但尚未报道尼达尼布引起的肾小球微血管病变。一名 68 岁男性，有原发性醛固酮增多症、特发性肺纤维化和肺多形性癌病史，在开始使用尼达尼布后出现蛋白尿和腿部水肿。肾脏活检显示明显的内皮和系膜损伤。停用尼达尼布后蛋白尿改善。据我们所知，这是第二例尼达尼布诱导的肾小球微血管病变的病例报告。虽然目前尚不清楚接受尼达尼布治疗的患者发生肾病的发生率，但我们建议监测接受尼达尼布治疗的患者的尿蛋白排泄和血压，并进行肾脏活检以确定任何组织病理学变化。
