Tubulointerstitial nephritis and IgA nephropathy in a patient with advanced lung cancer treated with long-term gefitinib.
A 52-year-old Japanese female was admitted to our hospital for microhematuria, proteinuria and progressive renal dysfunction. Two years prior to admission, she was diagnosed with lung adenocarcinoma and multiple bone and brain metastases, and was treated with gefitinib (250 mg/day). Treatment for 6 months induced partial response with 30% regression of the primary lung tumor, and resolution of metastatic tumors. After confirmation of the partial remission state, we performed percutaneous renal biopsy. Glomeruli showed mild to moderate mesangial proliferation, segmental endocapillary proliferation and occasional fibrocellular crescent formation. In addition, severe interstitial fibrosis and tubular atrophy relative to the degree of glomerular sclerosis were noted. Immunofluorescence microscopy showed predominant IgA deposition in the mesangial area. Electron microscopy revealed subepithelial and paramesangial electron-dense deposits. In consideration of the prognosis of lung cancer and complication of immunosuppressive treatment, we continued gefitinib only and closely followed-up the clinical course in the outpatient clinic. Sixteen months later, she continued to have proteinuria and microhematuria, and the severity of renal dysfunction was still the same. However, the lung cancer started to increase in size. This is quite an unusual case presenting histologically with tubulointerstitial nephritis and IgA nephropathy in a patient on long-term treatment with gefitinib.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Kidney Care Unit, Kyushu University Hospital, Fukuoka, Japan.
Kohsuke
K
Masutani
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Kidney Care Unit, Kyushu University Hospital, Fukuoka, Japan.
Kiichiro
K
Fujisaki
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Kidney Care Unit, Kyushu University Hospital, Fukuoka, Japan.
Hiroto
H
Maeda
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Jiro
J
Toyonaga
Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, Japan.
Ichiro
I
Inoshima
Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, Japan.
Koichi
K
Takayama
Division of Internal Medicine, National Fukuoka-Higashi Medical Center, Koga, Japan.
Ritsuko
R
Katafuchi
Kidney Unit, Fukuoka Red Cross Hospital, Fukuoka, Japan.
Hideki
H
Hirakata
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tsuruya@intmed2.med.kyushu-u.ac.jp.|Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan. tsuruya@intmed2.med.kyushu-u.ac.jp.
Kazuhiko
K
Tsuruya
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Mitsuo
M
Iida
D000230:Adenocarcinoma / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D004305:Dose-Response Relationship, Drug; D005260:Female; D000077156:Gefitinib; D005922:Glomerulonephritis, IGA / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D008175:Lung Neoplasms / Q000188:drug therapy*; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D011799:Quinazolines / Q000009:adverse effects* / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib