A case of crescentic glomerulonephritis induced by afatinib for lung adenocarcinoma

Afatinib is a second-generation, oral, epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). One of the most common adverse effects of affatinib is diarrhea, which may lead to acute kidney injury (AKI) due to severe plasma volume loss; however, no case of glomerular injury directly...

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Veröffentlicht in:CEN case reports 2023-05, Vol.12 (2), p.152-158
Hauptverfasser: Morita, Daisuke, Ito, Kenji, Ikeuchi, Nobumitsu, Nishida, Yoshihiro, Igata, Fumiyasu, Nakamura, Tsubasa, Murayama, Hiroyuki, Watanabe, Maho, Takahashi, Koji, Yasuno, Tetsuhiko, Uesugi, Noriko, Fujita, Masaki, Oda, Takashi, Masutani, Kosuke
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container_issue 2
container_start_page 152
container_title CEN case reports
container_volume 12
creator Morita, Daisuke
Ito, Kenji
Ikeuchi, Nobumitsu
Nishida, Yoshihiro
Igata, Fumiyasu
Nakamura, Tsubasa
Murayama, Hiroyuki
Watanabe, Maho
Takahashi, Koji
Yasuno, Tetsuhiko
Uesugi, Noriko
Fujita, Masaki
Oda, Takashi
Masutani, Kosuke
description Afatinib is a second-generation, oral, epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). One of the most common adverse effects of affatinib is diarrhea, which may lead to acute kidney injury (AKI) due to severe plasma volume loss; however, no case of glomerular injury directly induced by afatinib has been reported to date. Here, we describe the case of a 53-year-old Japanese male patient with advanced lung adenocarcinoma who twice developed AKI requiring dialysis, once after starting and once after increasing the dose of afatinib. Although serum anti-neutrophil cytoplasmic antibodies were negative, crescentic glomerulonephritis with no immune deposits was confirmed on kidney biopsy. No vasculitis-like signs were observed in other organs, such as lung, skin, or peripheral nerves. Afatinib was considered the cause of glomerular damage and was immediately discontinued; corticosteroids were administered. Renal function gradually recovered thereafter, with serum creatinine levels at ~ 2.3 mg/dL after second-line therapy with bevacizumab and atezolizumab. Several cases of cutaneous leukocytoclastic vasculitis have been reported in patients treated with other EGFR-TKIs; therefore, afatinib-induced vasculitis may lead to crescentic glomerulonephritis. Although afatinib-induced glomerular injury is extremely rare and has an unclear mechanism, renal function and urinary findings need to be closely monitored.
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source MEDLINE; Springer Online Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central
subjects Adenocarcinoma - drug therapy
Adenocarcinoma of Lung - drug therapy
Afatinib - therapeutic use
Case Report
ErbB Receptors - metabolism
Glomerulonephritis - drug therapy
Humans
Lung Neoplasms - pathology
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Quinazolines - pharmacology
Quinazolines - therapeutic use
Renal Dialysis
Urology
title A case of crescentic glomerulonephritis induced by afatinib for lung adenocarcinoma
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