Monday, February 15, 2016

New Biopsy Proven Renal toxicities in the Onconephrology World

BRAF inhibitors have revolutionized the treatment of melanoma recently.  While vemurafenib has had several reported cases of AKI, no biopsy proven cases of dabrafenib induced AIN have been reported. A recent review summarizes the renal toxic effects with BRAF inhibitors.  Early on, the injury likely is AIN and much later in treatment-likely ATN.  Finally, a biopsy proven case of AIN just got published with dabrafenib. This helps illustrate that the effects are more immunologic affecting the interstitial comportment. In addition, steroids improved the damage. Re-challenge didn’t allow for recurrence of AIN. 

BRAF inhibitor related toxicity summary

Allergic interstitial disease            
Acute tubular necrosis
Proximal tubular damage
Sub nephrotic range proteinuria

Also, anti  CTLA-4 agents such as ipilimumab have known to have similar AIN like effects in the kidney. Lupus like nephritis also has been reported. Most recent, a biopsy proven AIN with minimal change disease was reported with this agent.  

Glomerular diseases reported thus far with this agent are:- Lupus like nephritis( membranous GN pattern), MCD and other autoimmune nephritis( but more likely AIN).

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