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2017 ; 96
(25
): e7196
Nephropedia Template TP
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English Wikipedia
Glomerulonephritis and granulomatous vasculitis in kidney as a complication of
the use of BRAF and MEK inhibitors in the treatment of metastatic melanoma: A
case report
#MMPMID28640105
Maanaoui M
; Saint-Jacques C
; Gnemmi V
; Frimat M
; Lionet A
; Hazzan M
; Noël C
; Provot F
Medicine (Baltimore)
2017[Jun]; 96
(25
): e7196
PMID28640105
show ga
RATIONALE: BRAF and MEK inhibitors have significantly improved the prognosis of
metastatic melanoma, by inhibiting both the mitogen-activated protein kinase
(MAP-kinase) pathway. They are associated with infrequent adverse kidney events.
Most of these are related to the use of BRAF inhibitors and involve interstitial
nephritis with acute tubular necrosis. PATIENT CONCERNS: We report a unique case
of glomerulonephritis with renal granulomatous vasculitis in a patient diagnosed
with metastatic melanoma treated with BRAF and MEK inhibitors. The patient was a
55-year old woman, who presented a melanoma of the right thigh with pulmonary
metastasis. Treatment started in November 2015, with Encorafenib and Binimetinib,
new BRAF and MEK inhibitors, respectively. Two months after the beginning of the
treatment, there was a worsening of her renal function with significant
proteinuria. DIAGNOSES: Kidney biopsy showed extracapillary proliferation in the
glomeruli with a granulomatous reaction. INTERVENTIONS AND OUTCOMES: Renal
function recovered completely after withdrawal of the chemotherapy. LESSONS: All
the reported kidney adverse events secondary to BRAF and MEK inhibitors in the
literature are related to the use of BRAF inhibitors. Some previous reported
mechanistic investigations also provide insight between BRAF inhibitors and
podocytes injuries. Therefore, encorafenib most likely is the main responsible of
the disease. However, evidence has emerged that inhibition of the MAP kinase
pathway could also enhance autoimmunity. Thus, binimetinib may also have played a
role and the combination of BRAF and MEK inhibitors may have facilitated this
autoimmune kidney disease.
|Antineoplastic Agents/*adverse effects/therapeutic use
[MESH]
|Benzimidazoles/adverse effects/therapeutic use
[MESH]
|Carbamates/adverse effects/therapeutic use
[MESH]