The Detection of Urinary Podocytes from Drug-Induced Glomerular Thrombotic Microangiopathy in Advanced Cancer Patients.
BACKGROUND
Focusing on glomerular thrombotic microangiopathy (TMA), we detected urinary podocytes to evaluate podocyte damage following glomerular endothelial cell injury.


METHODS
We analyzed the relationship between urinary podocytes as biomarkers for podocyte injuries and clinical manifestations in five patients of anti-cancer-drug-induced glomerular TMA.


RESULTS
Cancer in all five patients was advanced, including 4 cases of renal cell carcinoma treated with tyrosine kinase inhibitor, and one with intrahepatic bile duct carcinoma treated with gemcitabine. Urinary podocytes were detected in 2 cases that rapidly developed acute kidney injury (AKI) and nephrotic syndrome, while they were not detected in 3 cases of slowly progressive chronic renal failure. One case with AKI, presenting sequential manifestations of urinary podocytes, showed the decrease and disappearance of urinary podocytes in accordance with the cessation of the anti-cancer drug, followed by improvement in renal function and in clinical symptoms such as hypertension.


CONCLUSIONS
These findings indicate that severe endothelial cell dysfunction during the acute phase of glomerular TMA leads to podocyte loss.
Joichi
J
Usui
Chie
C
Yokoyama
Masahiro
M
Hagiwara
Kai
K
Hirayasu
Takahiro
T
Kojima
Takayuki
T
Yoshino
Hiroyuki
H
Nishiyama
Masanori
M
Hara
Kunihiro
K
Yamagata
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000473:pathology* / Q000652:urine; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009404:Nephrotic Syndrome / Q000139:chemically induced / Q000473:pathology* / Q000652:urine; D050199:Podocytes / Q000187:drug effects / Q000473:pathology*; D011237:Predictive Value of Tests; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D057049:Thrombotic Microangiopathies / Q000139:chemically induced / Q000473:pathology* / Q000652:urine; D013997:Time Factors; D016482:Urinalysis / Q000379:methods; D014556:Urine / Q000166:cytology; D000093542:Gemcitabine
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D003841:Deoxycytidine; D000093542:Gemcitabine