ElShaer Ahmed, Almasry Mazen, Alawar Maher, Masoud Hassan, El Kinge Abdul Rahman
Internal Medicine, Alfaisal University College of Medicine, Riyadh, SAU.
Nephrology, Specialized Medical Center, Riyadh, SAU.
Cureus. 2021 Dec 10;13(12):e20330. doi: 10.7759/cureus.20330. eCollection 2021 Dec.
Second-generation tyrosine kinase inhibitors (TKI), such as nilotinib and dasatinib, are used in the first-line treatment of chronic myeloid leukemia (CML), usually after the failure or resistance to imatinib. Despite a good safety profile, medications in this category have an increased incidence of specific adverse events such as pulmonary hypertension, pleural effusion, and cardiovascular/peripheral arterial events. However, renal complications are rarely reported and observed. We herein report a case of a 46-year-old patient with CML who developed nephrotic syndrome upon switching from imatinib to dasatinib therapy, with the resolution of symptoms upon treatment discontinuation and switching to nilotinib. Limited cases were reported in the literature. It is thought that the inhibition of the vascular endothelial growth factor (VEGF) pathway is the main mechanism leading to proteinuria. Dasatinib-induced nephrotic syndrome should be looked for as it can be resolved by either reducing the dose or stopping it altogether and switching to another TKI.
第二代酪氨酸激酶抑制剂(TKI),如尼罗替尼和达沙替尼,通常在对伊马替尼治疗失败或耐药后,用于慢性髓性白血病(CML)的一线治疗。尽管这类药物安全性良好,但仍有特定不良事件的发生率增加,如肺动脉高压、胸腔积液以及心血管/外周动脉事件。然而,肾脏并发症鲜有报道和观察到。我们在此报告一例46岁的CML患者,在从伊马替尼转换为达沙替尼治疗后出现肾病综合征,停药并换用尼罗替尼后症状缓解。文献中报道的病例有限。据认为,抑制血管内皮生长因子(VEGF)途径是导致蛋白尿的主要机制。应警惕达沙替尼诱导的肾病综合征,因为它可以通过减少剂量或完全停药并换用另一种TKI来解决。