TYROSINE KINASE INHIBITOR AND MASSIVE PROTEINURIA
Dr Patrick Manley1, Dr Nyi Aung1
1Toowoomba Hospital Renal Department, Toowoomba, Australia
Background: Levatinib is a multiple receptor tyrosine kinase inhibitor indicated for the treatment of radioactive iodine refractory differentiated thyroid cancer, unresectable hepatocellular carcinoma and advanced renal cell carcinoma.
Case Report: A sixty-eight year old gentleman presented to hospital under the oncology team with flank pain and worsening orthopnea after being treated with levatinib for the previous thirteen months for his Hurthle cell carcinoma of the thyroid. He was subsequently found to have persistent hypertension (160-180/80-90), nephrotic syndrome with nephrotic range proteinuria (20000 mg on 24 hour urine collection), hypoalbuminaemia (serum albumin 20 g/L) acute kidney injury (creatinine peaking at 277 umol/L) but no haematuria and relatively preserved lipid profile. His medical history was significant for thyroid hurthle cell carcinoma with pulmonary metastases – diagnosed December 2022, type 2 diabetes, hypertension and obstructive sleep apnoea. Imaging was unremarkable as was a glomerulonephritis screen and his proteinuria improved during his admission after stopping his lenvatinib. In the outpatient clinic, his proteinuria increased and a subsequent renal biopsy proved a thrombotic microangiopathy.
Conclusions: With the increasing use of targeted therapies, a clinician needs to be aware of the potential side effects when prescribing tyrosine kinase inhibitors.
Biography:
I am a dual nephrology/general medicine trainee with a keen interest in interventional and regional nephrology with a particular interest in Indigenous renal diseases and health equality.