title: Nephrotic-range proteinuria in a child with retinoic acid syndrome.
abstract: BACKGROUND
  All-trans retinoic acid (ATRA) is a vitamin A derivative that is used in combination with chemotherapy to treat acute promyelocytic leukemia (APL). A serious complication of ATRA is retinoic acid syndrome (RAS), which is characterized by an inflammatory reaction with capillary leakage and myeloid cell tissue invasion that presents with cardiopulmonary symptoms and occasionally acute kidney injury.
  
  
  METHODS
  We report the case of a 3-year-old child with APL who developed transient nephrotic-range proteinuria (max urine protein:creatinine ratio 8.6) during two episodes of RAS while on ATRA therapy. ATRA was temporarily discontinued and the patient was treated with a 3-day course of dexamethasone during each episode. He maintained normal renal function throughout and the proteinuria completely resolved.
  
  
  CONCLUSIONS
  This is the first reported occurrence of nephrotic-range proteinuria in a child treated with ATRA. Nephrologists should be aware that RAS is a serious complication of ATRA that may lead to proteinuria.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY 11040, USA. csethna@nshs.edu
authors.forename: Christine B
authors.initials: CB
authors.lastname: Sethna
authors.forename: Kiranmye
authors.initials: K
authors.lastname: Reddy
authors.forename: Carolyn
authors.initials: C
authors.lastname: Fein-Levy
authors.forename: Howard
authors.initials: H
authors.lastname: Trachtman
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002675:Child, Preschool; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D011507:Proteinuria / Q000139:chemically induced*; D014212:Tretinoin / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D014212:Tretinoin
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