Qin Ai-Bo, Tan Ying, Su Tao
Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.
Medicine (Baltimore). 2020 Oct 23;99(43):e22901. doi: 10.1097/MD.0000000000022901.
Chemotherapeutic agents of direct cell damage play a role in initiating thrombotic microangiopathy (TMA), however still being underdiagnosed. Decitabine (DAC) is a pyrimidine analogue of the nucleoside cytidine, which can lead to injury to endothelium. Biopsy-proven DAC-induced kidney injury is rare.
A 47-year-old Chinese man with membranous nephropathy presented recurrent edema and acute kidney injury after a 3-day course of low dose DAC infusion because of cyclophosphamide-relating thrombocytopenia.
Laboratory data revealed nephrotic syndrome, hematuria, renal glycosuria and hypokalemia with hyperchloridemia. Renal pathological findings revealed TMA with secondary glomerular crescents formation (28%), partial foot process effacement and acute tubular necrosis. A diagnosis of DAC-induced renal TMA was considered.
As DAC had been timely discontinued before admission, the patient only received supportive treatment.
The patient achieved rapid remission of acute kidney injury after DAC withdrawal, and his serum creatinine further decreased to normal level after 6 months.
Careful monitoring of renal function especially serum creatinine should be emphasized during DAC treatment.
直接导致细胞损伤的化疗药物在引发血栓性微血管病（TMA）中起作用，但仍诊断不足。地西他滨（DAC）是核苷胞苷的嘧啶类似物，可导致内皮损伤。经活检证实的DAC诱导的肾损伤很少见。
一名47岁的中国男性膜性肾病患者，因环磷酰胺相关血小板减少接受了3天低剂量DAC输注，之后出现反复水肿和急性肾损伤。
实验室数据显示为肾病综合征、血尿、肾性糖尿和低钾血症伴高氯血症。肾脏病理结果显示为TMA伴继发性肾小球新月体形成（28%）、部分足突消失和急性肾小管坏死。考虑诊断为DAC诱导的肾TMA。
由于入院前已及时停用DAC，患者仅接受了支持治疗。
患者在停用DAC后急性肾损伤迅速缓解，6个月后血清肌酐进一步降至正常水平。
在DAC治疗期间应强调仔细监测肾功能，尤其是血清肌酐。
