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Acute granulomatous interstitial nephritis in a patient with metastatic melanoma on targeted molecular therapy with dabrafenib and trametinib: a case report
Citation
Krelle, A and Kalapurackal Mathai, V and Kirkland, G and Nott, L and Jose, M, Acute granulomatous interstitial nephritis in a patient with metastatic melanoma on targeted molecular therapy with dabrafenib and trametinib: a case report, pp. 43-43. ISSN 1320-5358 (2020) [Conference Extract]
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Abstract
Background:Treatment with the combination of molecular targeted therapy, dabrafenib (BRAF inhibitor) plus trametinib (MEK1/MEK2 inhibitor)
has been shown to improve progression-free and overall survival in
unresectable or metastatic melanoma. Few renal side effects are reported and
only case reports exist of interstitial nephritis in relation to this combination
therapy.
Case report: We report a case of a 37-year-old male diagnosed with metastatic melanoma (BRAF V600E mutation) of the scalp (Breslow thickness
3.5 mm, Clark level 3) who developed interstitial nephritis five years into
treatment with combination dabrafenib plus trametinib. He had no other significant medical history. In late 2019 he developed a febrile illness with
lymphadenopathy and nodal biopsy showed necrotising granulomatous
lymphadenitis of unclear aetiology; infective investigations were negative
with no evidence of metastatic melanoma. Months later he developed an
asymptomatic acute kidney injury (AKI) with a serum creatinine of
174 μmol/L (eGFR 42 mL/min/1.73 m2
) with an albumin creatinine ratio
8.5 mg/mmol. Kidney biopsy revealed granulomatous interstitial nephritis
likely drug related, with three fibrocellular crescents; immunofluorescence
was negative and electron microscopy was normal. ANCA and investigations
into other causes of AKI were negative, and the biopsy changes were not
thought consistent with sarcoidosis. He was treated with prednisolone
1 mg/kg and ceased his targeted therapy with improvement in his renal function and no current evidence of melanoma disease progression.
Conclusion: Although rare, interstitial nephritis is a serious potential adverse
effect of combination dabrafenib plus trametinib therapy. It has now been
recognized in a number of case studies including ours and hence our case
highlights the importance of increased awareness of this side effect and regular monitoring of renal function in patients on this combination therapy.
Item Details
Item Type: | Conference Extract |
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Keywords: | chronic kidney disease, dialysis, end-stage kidney disease |
Research Division: | Biomedical and Clinical Sciences |
Research Group: | Clinical sciences |
Research Field: | Nephrology and urology |
Objective Division: | Health |
Objective Group: | Clinical health |
Objective Field: | Treatment of human diseases and conditions |
UTAS Author: | Kirkland, G (Dr Geoffrey Kirkland) |
UTAS Author: | Nott, L (Dr Louise Nott) |
UTAS Author: | Jose, M (Professor Matthew Jose) |
ID Code: | 142059 |
Year Published: | 2020 |
Deposited By: | Medicine |
Deposited On: | 2020-12-10 |
Last Modified: | 2021-05-21 |
Downloads: | 0 |
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