Case Reports in Nephrology and Dialysis
Published: November 2012
Relapsing Acute Kidney Injury Associated with PegfilgrastimArora S.a · Bhargava A.a · Jasnosz K.b · Clark B.aaDivision of Nephrology and Hypertension, Department of Medicine, and bDepartment of Pathology, Allegheny General Hospital, Temple University School of Medicine, Pittsburgh, Pa., USA
Assoc. Prof. Barbara Clark, MD Division of Nephrology and Hypertension Allegheny General Hospital, 320 East North Avenue Pittsburgh, PA 15212 (USA) E-Mail baclarkmd76@hotmail.com |
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Abstract
We report a previously unrecognized complication of severe acute kidney injury (AKI) after the administration of pegfilgrastim with biopsy findings of mesangioproliferative glomerulonephritis (GN) and tubular necrosis. A 51-year-old white female with a history of breast cancer presented to the hospital with nausea, vomiting and dark urine 2 weeks after her third cycle of cyclophosphamide and docetaxel along with pegfilgrastim. She was found to have AKI with a serum creatinine (Cr) level of 6.9 mg/dl (baseline 0.7). At that time, her AKI was believed to be related to prior sepsis and/or daptomycin exposure that had occurred 5 weeks earlier. She was dialyzed for 6 weeks, after which her kidney function recovered to near baseline, but her urinalysis (UA) still showed 3.5 g protein/day and dysmorphic hematuria. Repeat blood cultures and serological workup (complement levels, hepatitis panel, ANA, ANCA and anti-GBM) were negative. She received her next cycle of chemotherapy with the same drugs. Two weeks later, she developed recurrent AKI with a Cr level of 6.7 mg/dl. A kidney biopsy showed mesangioproliferative GN, along with tubular epithelial damage and a rare electron-dense glomerular deposit. Pegfilgrastim was suspected as the inciting agent after exclusion of other causes. Her Cr improved to 1.4 mg/dl over the next 3 weeks, this time without dialysis. She had the next 2 cycles of chemotherapy without pegfilgrastim, with no further episodes of AKI. A literature review revealed a few cases of a possible association of filgrastim with mild self-limited acute GN. In conclusion, pegfilgrastim may cause GN with severe AKI. Milder cases may be missed and therefore routine monitoring of renal function and UA is important.
© 2012 S. Karger AG, Basel
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Article / Publication Details
Published online: November 21, 2012
Issue release date: July – December
Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 0
eISSN: 2296-9705 (Online)
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