Decitabine-induced kidney thrombotic microangiopathy with glomerular crescents formation and tubular necrosis: A case report.

Abstract

INTRODUCTION:

Chemotherapeutic agents of direct cell damage play a role in initiating thrombotic microangiopathy (TMA), however still being underdiagnosed. Decitabine (DAC) is a pyrimidine analogue of the nucleoside cytidine, which can lead to injury to endothelium. Biopsy-proven DAC-induced kidney injury is rare.

PATIENT CONCERNS:

A 47-year-old Chinese man with membranous nephropathy presented recurrent edema and acute kidney injury after a 3-day course of low dose DAC infusion because of cyclophosphamide-relating thrombocytopenia.

DIAGNOSIS:

Laboratory data revealed nephrotic syndrome, hematuria, renal glycosuria and hypokalemia with hyperchloridemia. Renal pathological findings revealed TMA with secondary glomerular crescents formation (28%), partial foot process effacement and acute tubular necrosis. A diagnosis of DAC-induced renal TMA was considered.

INTERVENTIONS:

As DAC had been timely discontinued before admission, the patient only received supportive treatment.

OUTCOMES:

The patient achieved rapid remission of acute kidney injury after DAC withdrawal, and his serum creatinine further decreased to normal level after 6 months.

CONCLUSION:

Careful monitoring of renal function especially serum creatinine should be emphasized during DAC treatment.

• Authors: Ai-Bo Qin, Ying Tan, Tao Su
• Journal: Medicine (Medicine (Baltimore)) Vol. 99 Issue 43 Pg. e22901 (Oct 23 2020) ISSN: 1536-5964 [Electronic] United States
• PMID: 33120841 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antimetabolites, Antineoplastic
• Immunosuppressive Agents
• Decitabine
• Cyclophosphamide

Topics

• Acute Kidney Injury (etiology)
• Antimetabolites, Antineoplastic (adverse effects)
• Conservative Treatment
• Cyclophosphamide (adverse effects)
• Decitabine (adverse effects)
• Glomerulonephritis, Membranous (pathology)
• Humans
• Immunosuppressive Agents (adverse effects)
• Kidney (blood supply, pathology)
• Kidney Glomerulus (pathology)
• Male
• Middle Aged
• Nephrotic Syndrome (diagnosis, etiology)
• Thrombocytopenia (chemically induced)
• Thrombotic Microangiopathies (chemically induced)
• Withholding Treatment