Fanconi syndrome in an elderly patient with membranous nephropathy during treatment with the immunosuppressant mizoribine.
Fanconi syndrome in an elderly patient with membranous nephropathy during treatment with the immunosuppressant mizoribine.
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DOI：
10.1007/s13730-022-00715-0
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发表时间：
2023-03
期刊：
影响因子：
1
通讯作者：
Iwano, Masayuki
中科院分区：
文献类型：
--
作者：
Nishikawa, Sho;Takahashi, Naoki;Nishikawa, Yudai;Yokoi, Seiji;Morita, Sayu;Shimamoto, Yuki;Sakashita, Sayumi;Nishimori, Kazuhisa;Kobayashi, Mamiko;Fukushima, Sachiko;Mikami, Daisuke;Kimura, Hideki;Kasuno, Kenji;Naiki, Hironobu;Iwano, Masayuki
我们报告一位80岁男性，在服用咪唑立宾治疗膜性肾病4周后，被诊断为范可尼综合征。咪唑立宾是一种口服免疫抑制剂，可抑制肌苷一磷酸脱氢酶，在日本广泛用于治疗自身免疫性疾病和肾病综合征，以及肾移植后。获得性范可尼综合征通常由药物（抗菌药物、抗病毒药、抗癌药和抗惊厥药）引起，有时由自身免疫性疾病、单克隆轻链相关疾病或重金属中毒引起。在我们的患者中，尽管口服泼尼松龙后单次静脉注射利妥昔单抗，但在停用咪唑立宾后，低钾血症、低磷血症、糖尿、低尿酸血症和严重蛋白尿逐渐消退。根据患者的临床病程和典型实验室数据，患者最终被诊断为咪唑立宾诱导的范可尼综合征，无近端肾小管酸中毒。据我们所知，这是首次报道的范可尼综合征可能由咪唑立宾。虽然咪唑立宾诱导近端肾小管功能障碍的确切机制尚不清楚，但我们建议肾病学家应注意范可尼综合征的发生，这是咪唑立宾治疗期间的一种罕见并发症。在线版本包含补充材料，可通过10.1007/s13730-022-00715-0获得。
We report on an 80-year-old man diagnosed with Fanconi syndrome induced by mizoribine after 4 weeks of administration to treat membranous nephropathy. Mizoribine is an oral immunosuppressant that inhibits inosine monophosphate dehydrogenase and is widely used in Japan for the treatment of autoimmune diseases and nephrotic syndrome, as well as after renal transplantation. Acquired Fanconi syndrome is often caused by drugs (antibacterial, antiviral, anticancer, and anticonvulsant drugs) and is sometimes caused by autoimmune diseases, monoclonal light chain-associated diseases, or heavy metal poisoning. In our patient, hypokalemia, hypophosphatemia, glucosuria, hypouricemia, and severe proteinuria resolved gradually after discontinuation of mizoribine administration, despite oral administration of prednisolone followed by a single intravenous injection of rituximab. The patient was ultimately diagnosed with Fanconi syndrome induced by mizoribine based on his clinical course and his typical laboratory data with the absence of proximal tubular acidosis. To our knowledge, this is the first report of Fanconi syndrome possibly induced by mizoribine. Although the precise mechanism by which mizoribine induces proximal tubular dysfunction is unknown, we suggest that nephrologists should be aware of the onset of Fanconi syndrome, a rare complication during mizoribine treatment. The online version contains supplementary material available at 10.1007/s13730-022-00715-0.