title: Early detection of renal damage caused by fumaric acid ester therapy by determination of urinary β2-microglobulin.
abstract: BACKGROUND
  Fumaric acid esters are considered efficacious and safe drugs for the treatment of psoriasis. Renal damage, caused either by acute renal injury or Fanconi syndrome, is a recognized side-effect of this therapy.
  
  
  OBJECTIVE
  To investigate whether the measurement of urinary excretion of β2-microglobulin, a marker of renal proximal tubular dysfunction, allows early detection of kidney damage before an increase in serum creatinine or significant proteinuria occurs.
  
  
  METHODS
  Urinary β2-microglobulin excretion was measured regularly in 23 patients undergoing fumaric acid ester therapy.
  
  
  RESULTS
  Urinary β2-microglobulin remained normal in all 10 male patients. Three (23%) out of 13 female patients experienced an increase in urinary β2-microglobulin excretion. In two of these patients a sharp increase was observed in association with high doses. One further patient had moderately elevated levels on rather low doses of fumaric acid esters. After discontinuing treatment, urinary β2-microglobulin levels returned to normal within a few weeks.
  
  
  CONCLUSIONS
  Determination of urinary β2-microglobulin possibly allows early detection of renal damage by fumaric acid esters. Female patients seem to be prone to this side-effect, especially when taking high doses.
authors.affiliation: Department of Dermatology, Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Häring
authors.forename: H Sprenger
authors.initials: HS
authors.lastname: Mähr
authors.forename: M
authors.initials: M
authors.lastname: Mündle
authors.forename: R
authors.initials: R
authors.lastname: Strohal
authors.forename: K
authors.initials: K
authors.lastname: Lhotta
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000652:urine; D000328:Adult; D015415:Biomarkers / Q000652:urine; D042241:Early Diagnosis; D005260:Female; D005650:Fumarates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy; D001613:beta 2-Microglobulin / Q000652:urine*
chemical_list: D015415:Biomarkers; D005650:Fumarates; D001613:beta 2-Microglobulin; C032005:fumaric acid