Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
Department of Molecular Pathology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
CEN Case Rep. 2023 Feb;12(1):32-38. doi: 10.1007/s13730-022-00715-0. Epub 2022 Jun 24.
We report on an 80-year-old man diagnosed with Fanconi syndrome induced by mizoribine after 4 weeks of administration to treat membranous nephropathy. Mizoribine is an oral immunosuppressant that inhibits inosine monophosphate dehydrogenase and is widely used in Japan for the treatment of autoimmune diseases and nephrotic syndrome, as well as after renal transplantation. Acquired Fanconi syndrome is often caused by drugs (antibacterial, antiviral, anticancer, and anticonvulsant drugs) and is sometimes caused by autoimmune diseases, monoclonal light chain-associated diseases, or heavy metal poisoning. In our patient, hypokalemia, hypophosphatemia, glucosuria, hypouricemia, and severe proteinuria resolved gradually after discontinuation of mizoribine administration, despite oral administration of prednisolone followed by a single intravenous injection of rituximab. The patient was ultimately diagnosed with Fanconi syndrome induced by mizoribine based on his clinical course and his typical laboratory data with the absence of proximal tubular acidosis. To our knowledge, this is the first report of Fanconi syndrome possibly induced by mizoribine. Although the precise mechanism by which mizoribine induces proximal tubular dysfunction is unknown, we suggest that nephrologists should be aware of the onset of Fanconi syndrome, a rare complication during mizoribine treatment.
我们报告了一例 80 岁男性患者，在服用米佐米滨治疗膜性肾病 4 周后被诊断为范可尼综合征。米佐米滨是一种口服免疫抑制剂，可抑制肌苷单磷酸脱氢酶，在日本被广泛用于治疗自身免疫性疾病和肾病综合征，以及肾移植后。获得性范可尼综合征通常由药物（抗菌药、抗病毒药、抗癌药和抗惊厥药）引起，有时也由自身免疫性疾病、单克隆轻链相关疾病或重金属中毒引起。在我们的患者中，尽管给予泼尼松龙口服治疗，随后给予利妥昔单抗单次静脉注射，但米佐米滨停药后低钾血症、低磷血症、糖尿、低尿酸血症和严重蛋白尿逐渐得到纠正。根据患者的临床病程和典型实验室数据，排除近端肾小管酸中毒，最终诊断为米佐米滨诱导的范可尼综合征。据我们所知，这是首例可能由米佐米滨引起的范可尼综合征报告。尽管米佐米滨诱导近端肾小管功能障碍的确切机制尚不清楚，但我们建议肾病学家应注意米佐米滨治疗期间罕见的范可尼综合征并发症的发生。
