Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan.
CEN Case Rep. 2024 Dec;13(6):510-516. doi: 10.1007/s13730-024-00881-3. Epub 2024 Apr 24.
A 62-year-old female patient with essential thrombocythemia experienced rapid renal dysfunction and was subsequently referred to our hospital. Further investigations did not reveal any significant abnormalities except for a slight increase in urinary β2-microglobulin levels. A renal biopsy was performed to investigate the cause of her renal dysfunction, revealing acute tubular necrosis, interstitial edema, and arteriosclerosis. No significant glomerular lesions were observed. Immunofluorescence staining and electron microscopy showed no abnormalities. She had been using anagrelide for 4 years, and her dosage was increased from 2.0 to 3.0 mg/day 10 months before her initial admission. Her renal function began to deteriorate 2 months after the anagrelide dosage increase. Although 0.625 mg of bisoprolol was initiated for tachycardia 3 months after the anagrelide dosage adjustment, we suspected that the acute tubular necrosis was associated with anagrelide administration. After transitioning from anagrelide to hydroxyurea and discontinuing bisoprolol, her renal function improved. This case suggests the importance of considering anagrelide as a potential cause of renal dysfunction in patients using this medication. Therefore, renal biopsy, combined with a comprehensive medical history, is crucial for evaluating the etiology of renal injury in such cases.
一位 62 岁女性原发性血小板增多症患者出现肾功能迅速恶化，随后转至我院。进一步检查除了尿β2-微球蛋白水平轻度升高外，未见其他明显异常。为明确肾损伤病因进行了肾活检，结果显示急性肾小管坏死、间质水肿和动脉硬化，肾小球未见明显病变。免疫荧光染色和电子显微镜检查均未见异常。患者已使用安那格雷 4 年，在最初入院前 10 个月，将剂量从 2.0mg/天增加到 3.0mg/天。增加安那格雷剂量后 2 个月，她的肾功能开始恶化。尽管在调整安那格雷剂量后 3 个月因心动过速开始使用比索洛尔（0.625mg），但我们怀疑急性肾小管坏死与安那格雷有关。将安那格雷转换为羟基脲并停用比索洛尔后，她的肾功能得到改善。该病例提示，在使用该药物的患者中，应考虑安那格雷可能是导致肾功能障碍的原因之一。因此，对于此类患者，结合全面的病史进行肾活检对于评估肾损伤病因至关重要。
