Interferon-?-associated focal segmental glomerulosclerosis with massive proteinuria in patients with chronic myeloid leukemia following high dose chemotherapy

Shah, Manisha H.; Jenis, Edwin H.; Mookerjee, Basab K.; Schriber, Jeffrey; Herzig, Geoffrey P.; Wetzler, Meir

doi:10.1002/(sici)1097-0142(19981101)83:9<1938::aid-cncr9>3.0.co;2-m

Cited by 43 publications

(16 citation statements)

References 39 publications

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“…IFN was discontinued in all patients, and eight also received steroids. A decline in proteinuria and improvement in renal function were documented in nine of 10 patients with available follow-up, although only one patient had a CR (39) and only three had a PR (40,44,46). Of note, all three reported patients with collapsing FSGS were receiving IFN-␣, including one (28) from our center, who also is included in this study (patient 2).…”

Section: Discussionmentioning

confidence: 94%

Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis

Markowitz¹,

Nasr²,

Stokes³

et al. 2010

Clinical Journal of the American Society of Nephrology

204

180

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Background and objectives: Treatment with IFN is rarely associated with nephrotic syndrome and renal biopsy findings of minimal-change disease or FSGS.Design, setting, participants, & measurements: We report 11 cases of collapsing FSGS that developed during treatment with IFN and improved after discontinuation of therapy.Results: The cohort consists of seven women and four men with a mean age of 48.2 yr. Ten of the 11 patients were black. Six patients were receiving IFN-␣ for hepatitis C virus infection (n ‫؍‬ 5) or malignant melanoma (n ‫؍‬ 1), three were receiving IFN-␤ for multiple sclerosis, and two were treated with IFN-␥ for idiopathic pulmonary fibrosis. After a mean and median duration of therapy of 4.0 and 12.6 months, respectively, patients presented with acute renal failure (mean creatinine 3.5 mg/dl) and nephrotic-range proteinuria (mean 24-hour urine protein 9.7 g). Renal biopsy revealed collapsing FSGS with extensive foot process effacement and many endothelial tubuloreticular inclusions. Follow-up was available for 10 patients, all of whom discontinued IFN. At a mean of 23.6 months, nine of 10 patients had improvement in renal function, including one with complete remission and two with partial remission. Among the seven patients with available data, mean proteinuria declined from 9.9 to 3.0 g/d. Four of the seven patients were treated with immunosuppression, and there was no detectable benefit.Conclusions: Collapsing FSGS may occur after treatment with IFN-␣, -␤, or -␥ and is typically accompanied by the ultrastructural finding of endothelial tubuloreticular inclusions. Optimal therapy includes discontinuation of IFN.

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Section: Discussionmentioning

confidence: 94%

Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis

Markowitz¹,

Nasr²,

Stokes³

et al. 2010

Clinical Journal of the American Society of Nephrology

204

180

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“…9 10 Three patients with CML developed minimal change nephropathy 11 12 and rapidly progressing glomerulonephritis. 13 To examine the impact of IFNa on the pathological findings in the kidney, we investigated the induction of haemolysis by patient's serum and IFNa in vitro, in a modified Coombs test.…”

Section: Discussionmentioning

confidence: 99%

Interferon α sensitisation induced fatal renal insufficiency in a patient with chronic myeloid leukaemia: case report and review of literature: Figure 1

Čolović

Jurišić²,

Janković³

et al. 2006

J Clin Pathol

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Renal dysfunction as a sequel to extended interferon alfa (IFNalpha) treatment in chronic myeloid leukaemia (CML) has been reported previously in six patients. An additional patient is presented with Philadelphia chromosome positive (Ph+) CML and nephrotic syndrome in whom initial renal insufficiency developed after only one month of low dose IFNalpha therapy. The renal biopsy showed a focal segmental mononuclear cell infiltration, basal membrane thickening, and deposits of immunoglobulins (IgG; IgAGM IC3). In spite of discontinuation of IFNalpha, renal function deteriorated and the patient died six months later. This case represents an instance of fatal kidney insufficiency as an untoward effect of sensitisation to the IFNalpha, confirmed by modified Coombs assay.

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“…Shah et al 8 reported 2 cases in patients with CML who underwent treatment with ICE (idarubicin, cytarabine, and etoposide) and IFN␣. The difference in our case is the preexisting hepatitis C diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Underlying malignancies include CML, multiple myeloma, mycosis fungoides, metastatic renal cell carcinoma and metastatic gastric carcinoma. 8,[12][13][14][15][16][17][18][19][20][21][22][23][24] In CML there have been three previous reports of renal dysfunction consisting of two minimal-change nephropathy cases and one case of rapidly progressive glomerulonephritis. [25][26][27] CML with IFN␣ therapy shows a spectrum of disease processes.…”

Section: Discussionmentioning

confidence: 99%

Interferon-Alpha–Induced Focal Segmental Glomerulosclerosis in Chronic Myelogenous Leukemia

Bremer

Lastrapes

Alper

et al. 2003

American Journal of Clinical Oncology

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Chronic myelogenous leukemia (CML), hepatitis C, and interferon alpha (IFNalpha) have all been associated with renal dysfunction. In this paper we present a patient with the diagnosis of nephrotic syndrome and a known history of hepatitis C who received IFNalpha therapy for newly diagnosed CML. The renal biopsy showed focal segmental glomerulosclerosis, which has only been previously reported in two cases of CML treated with IFNalpha. There have also been two cases of patients with hepatitis C associated with focal segmental glomerulosclerosis. Despite the underlying hepatitis C, this case represents renal abnormalities consistent with IFNalpha therapy for CML.

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Interferon-?-associated focal segmental glomerulosclerosis with massive proteinuria in patients with chronic myeloid leukemia following high dose chemotherapy

Cited by 43 publications

References 39 publications

Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis

Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis

Interferon α sensitisation induced fatal renal insufficiency in a patient with chronic myeloid leukaemia: case report and review of literature: Figure 1

Interferon-Alpha–Induced Focal Segmental Glomerulosclerosis in Chronic Myelogenous Leukemia

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