SPECTRUM OF KIDNEY INJURY ON RENAL BIOPSY FOLLOWING ANTICANCER DRUG TREATMENT

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Abstract Title *

SPECTRUM OF KIDNEY INJURY ON RENAL BIOPSY FOLLOWING ANTICANCER DRUG TREATMENT

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Co-author 1

MANOJ JAIN mnjjain@yahoo.com Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Pathology Lucknow India *

Co-author 2

PALLAVI PRASAD pallavi111985@gmail.com Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Pathology Lucknow India -

Co-author 3

ANUPMA KAUL anupmaneph@gmail.com Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Nephrology Lucknow India -

Co-author 4

VINITA AGARWAL vinita.agrawal15@gmail.com Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Pathology Lucknow India -

Co-author 5

NARAYAN PRASAD narayan.nephro@gmail.com Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Nephrology Lucknow India -

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Introduction

Anticancer drugs like platinum-based chemotherapeutic agents, alkylating agents, targeted agents including tyrosine kinase inhibitors, Alk inhibitors; and immunotherapeutic agents like Interferons, CTLA-4 inhibitors, PD-1 inhibitors, affect all renal compartments including glomeruli, tubules, interstitium; and blood vessels. Anticancer drugs cause renal injury by variety of mechanisms e.g. direct cellular toxicity causing acute tubular injury (ATI), oxidative stress and Inflammation causing ATI and acute interstitial nephritis (AIN), altered hemodynamics causing thrombotic microangiopathy (TMA). Immune-mediated response may cause FSGS or TIN; and crystal deposition in tubules causing crystal nephropathy.

Methods

Renal Biopsies from four patients following anticancer drug treatment were received from 2017 to 2024 in a tertiary care centre in North India. Clinical details and histological findings were evaluated for the spectrum of renal lesions.

Results

The histological diagnoses of malignancy were poorly differentiated follicular carcinoma thyroid, PNET of maxilla, carcinoma of ovary and carcinoma of breast. Patients age were 60 years, 22 years, 51 years and 60 years respectively at diagnosis of carcinoma and initiation of starting anticancer drugs for malignancy. Male: Female ratio was 1:1. Anticancer drugs used were TKI (Levatinib), Vincristine, cyclophosphamide, doxorubicin, etoposide; Paclitaxel Based Chemotherapy; Cyclophosphamide, Paclitaxel and Etoposide; and Capecitabine. Post anticancer drug duration of renal injury and renal biopsy were 36 months, 62 months, 65 months; and one month. Renal symptoms were nephrotic range proteinuria, advanced renal failure with nephrotic range proteinuria and RPRF. Renal biopsy diagnoses were Focal Segemental Glomerulosclerosis (FSGS), ATI with C3 Nephropathy, IgA Nephropathy and Pauci-immune Crescentic Glomerulonephritis. On post renal biopsy follow-up of 1 month to 20 months, two patients succumbed; and two lost to follow-up.

Conclusion

Following anticancer drug treatment variety of lesions may be found affecting all renal compartments. Prompt diagnosis and treatment may prolong renal and patient survival.

Kewords