Thrombotic Microangiopathy, Podocytopathy, and Damage to the Renal Tubules with Severe Proteinuria and Acute Renal Dysfunction Induced by Lenvatinib

Intern Med. 2022 Oct 15;61(20):3083-3088. doi: 10.2169/internalmedicine.8365-21. Epub 2022 Mar 26.

Abstract

Lenvatinib, a tyrosine kinase inhibitor (TKI), is a stronger inhibitor of vascular endothelial growth factor receptor, fibroblast growth factor receptors 1 to 4, and platelet-derived growth factor receptor (PDGFR) than other TKIs. We herein report a 77-year-old Japanese woman who received the minimum dose of lenvatinib for treatment of hepatocellular carcinoma. Within one month of starting treatment, she developed severe proteinuria, hypertension, and renal dysfunction. A kidney biopsy showed drug-induced thrombotic microangiopathy, podocytopathy, and polar vasculosis. We also observed damage to the renal tubules, where PDGFR is located. To our knowledge, this is the first report of lenvatinib-induced damage to the renal tubules.

Keywords: damage to the renal tubules; lenvatinib; podocytopathy; thrombotic microangiopathy.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Agents* / therapeutic use
  • Female
  • Humans
  • Kidney Diseases* / drug therapy
  • Liver Neoplasms* / drug therapy
  • Phenylurea Compounds / adverse effects
  • Protein Kinase Inhibitors / therapeutic use
  • Proteinuria / chemically induced
  • Proteinuria / drug therapy
  • Quinolines* / adverse effects
  • Receptors, Fibroblast Growth Factor
  • Receptors, Platelet-Derived Growth Factor
  • Receptors, Vascular Endothelial Growth Factor
  • Thrombotic Microangiopathies* / drug therapy
  • Vascular Endothelial Growth Factor A

Substances

  • Antineoplastic Agents
  • Phenylurea Compounds
  • Protein Kinase Inhibitors
  • Quinolines
  • Receptors, Fibroblast Growth Factor
  • Vascular Endothelial Growth Factor A
  • Receptors, Platelet-Derived Growth Factor
  • Receptors, Vascular Endothelial Growth Factor
  • lenvatinib