title: Sunitinib-induced nephrotic syndrome and irreversible renal dysfunction.
abstract: Sunitinib, a tyrosine kinase inhibitor targeting vascular endothelial growth factor receptors (VEGFRs), has become essential for treating imatinib-resistant malignant gastrointestinal stromal tumor. Recently, several cases have been reported that showed proteinuria and kidney dysfunction to be associated with anti-VEGF therapy. Although previous reports indicated that this side-effect is reversible, it is not well understood. We present here the case of a 72-year-old man who presented with nephrotic syndrome and renal dysfunction 6 months after administration of sunitinib. Sunitinib was discontinued, and nephrotic syndrome remitted spontaneously, but renal function recovery was limited. Nine months later, a renal biopsy was performed because sunitinib was again required and pathological examination was needed. The renal biopsy showed marked endothelial cell injury with focal segmental glomerulosclerosis and accelerated VEGF expression by podocytes. Sunitinib was then given at a reduced dose. Kidney dysfunction and nephrotic syndrome are rare but serious complications of sunitinib. The present case suggests that long-term treatment with a high dose of sunitinib can cause irreversible renal dysfunction, and that low-dose treatment makes these side-effects manageable.
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. dtakahashi.kid@tmd.ac.jp
authors.forename: Daiei
authors.initials: D
authors.lastname: Takahashi
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Nagahama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tsuura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Teiichi
authors.initials: T
authors.lastname: Tamura
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy; D006801:Humans; D007211:Indoles / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D009404:Nephrotic Syndrome / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D011507:Proteinuria; D011758:Pyrroles / Q000009:adverse effects*; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib