Slowly Progressing Thrombotic Microangiopathy during Two Years of Treatment with Sunitinib

Korean Journal of Nephrology 2011;30(5):533-536.

Min Young Kim, M.D.1, Heejung Choi, M.D.2, Yoonjung Kim, M.D.2, Na Ree Kang, M.D.1, Hye Ryoun Jang, M.D.2, Ghee Young Kwon, M.D.3, Wooseong Huh, M.D.2, Young Suk Park, M.D.4, Yoon-Goo Kim, M.D.2, Dae Joong Kim, M.D.2, Ha Young Oh, M.D.2 and Jung Eun Lee,

Division of Nephrology¹
Department of Internal Medicine, Seoul Medical Center, Seoul, Korea Division of Nephrology²
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Pathology³
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Division of Hemato-oncology⁴
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

증례 : Slowly Progressing Thrombotic Microangiopathy during Two Years of Treatment with Sunitinib

Division of Nephrology1, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea Division of Nephrology2, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Pathology

Abstract

A 75-year-old man with mild renal impairment was started on sunitinib for a metastatic gastrointestinal stromal tumor. After 7 months of this therapy, proteinuria became aggravated. Serum creatinine concentration was increased from 1.34 to 2.57 mg/dL 24 months after sunitinib administration. Hematologic features of thrombotic microangiopathy (TMA) were absent. Renal histology revealed endothelial swelling and plasmatic insudation of the glomeruli. Proteinuria and renal function improved after discontinuation of sunitinib. Our experience suggests that TMA associated with sunitinib can be diverse in onset and severity, and that the hematologic features of TMA may be absent.

Key Words: VEGF, Sunitinib, Thrombotic microangiopathy