Dasatinib

Abstract

Focal segmental glomerulosclerosis and nephrotic syndrome : case report A 45-year-old woman developed focal segmental glomerulosclerosis and nephrotic syndrome during treatment with dasatinib for philadelphia chromosome positive chronic myeloid leukaemia (CML). The woman, who was diagnosed with philadelphia chromosome positive CML 3 year prior, started receiving dasatinib 100 mg/day [route not stated]. She achieved clinical and laboratory remission; however, she presented 2 months after dasatinib treatment due to lower limb swelling and proteinuria (+3) in urinalysis. She was then hospitalised. Physical examination showed BP 130/80mm Hg, BMI 24.7 kg/m2 and pretibial pitting oedema. Laboratory investigation showed 24 hour urinary protein 3.580mg, haemoglobin, 11.7 g/dL, WBC 5.940 k/μL, platelet count 223 k/μL, blood urea nitrogen 29 mg/dL, creatinine 0.9 mg/dL, total protein 6.6 g/dL, albumin 3.7 g/dL, glucose 89 mg/dL, ALT 31 U/L, plasma protein 6.6 g/dL, cholesterol 276 mg/dL, triglyserides 317 mg/dL and CRP 0.03 mg/L. Renal biopsy showed 32 glomeruli, total sclerosis in two glomeruli, segmental sclerosis and increased matrix in three glomeruli, and periglomerular fibrosis in two glomeruli. A segmental thickening in the basement membrane was also noted. Her interstitial fibrosis, interstitial lymphocytic infiltration, tubular atrophy and hyaline sclerotic changes in the arterioles were mild. Based on the findings, she was diagnosed with perihilar focal segmental glomerulosclerosis and nephrotic syndrome secondary to dasatinib. The woman’s therapy with dasatinib was discontinued. She was then treated with losartan, and proteinuria decreased progressively in 6 months. Renal functions and other biochemical findings remained within normal ranges. Laboratory investigation showed 24 hour urinary protein 85mg, haemoglobin, 12.0 g/dL, WBC 6.100 k/μL, platelet count 251 k/μL, blood urea nitrogen 22 mg/dL, creatinine 1.0 mg/dL, total protein 7.1 g/dL, albumin 4.3 g/dL, glucose 92 mg/dL, ALT 31 U/L, plasma protein 7.1 g/dL, cholesterol 189 mg/dL, triglyserides 202 mg/dL and CRP 0.01 mg/L. She was still under treatment and observation by our clinics.