Nieto-Ríos John Fredy, García-Prada Camilo Andrés, Aristizabal-Alzate Arbey, Zuluaga-Valencia Gustavo, Cadavid-Aljure Dahyana, Serna-Higuita Lina Maria, Arias Luis F
Departamento de Nefrología y Trasplante Renal, Hospital Pablo Tobón Uribe, Medellín, Colombia; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
Nefrologia (Engl Ed). 2021 Sep 18. doi: 10.1016/j.nefro.2021.08.004.
Nephrotic syndrome in patients with cancer may be related to the primary malignancy or chemotherapeutic therapy. Solid organ cancers may cause membranous glomerulonephritis manifesting with nephrotic syndrome; other less common histologic presentations include focal and segmental glomerulosclerosis and minimal change disease. In addition, chemotherapy agents can cause renal toxicity by affecting the small blood vessels, glomeruli, tubules, and interstitium. Tyrosine kinase inhibitors such as sunitinib may cause endothelial and podocyte damage leading to renal limited thrombotic microangiopathy, manifested by proteinuria and hypertension. We report a case of an elderly man with gastrointestinal stromal tumor (GIST) on treatment with sunitinib who had as a complication of a thrombotic microangiopathy manifested with nephrotic syndrome and difficult-to-control hypertension, which was controlled by stopping this drug but with a fatal outcome due to its malignant neoplasm.
癌症患者的肾病综合征可能与原发性恶性肿瘤或化疗有关。实体器官癌症可导致表现为肾病综合征的膜性肾小球肾炎；其他不太常见的组织学表现包括局灶节段性肾小球硬化和微小病变病。此外，化疗药物可通过影响小血管、肾小球、肾小管和间质而导致肾毒性。酪氨酸激酶抑制剂如舒尼替尼可能导致内皮细胞和足细胞损伤，进而导致肾局限性血栓性微血管病，表现为蛋白尿和高血压。我们报告一例老年男性胃肠道间质瘤（GIST）患者，接受舒尼替尼治疗，出现血栓性微血管病并发症，表现为肾病综合征和难以控制的高血压，停用该药后病情得到控制，但因恶性肿瘤导致了致命结局。
