多药联合治疗晚期原发性肝癌中的仑伐替尼致肾损害1例及文献复习  

Renal injury induced by lenvatinib in advanced hepatocellular carcinoma treated with multi-drug combination:a case report and literature review

作　　者：黄菊[1] 叶葳[2] 文煜冰[2] 郑可[2] Huang Ju;Ye Wei;Wen Yubing;Zheng Ke(Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Nephrology,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院,北京100730 [2]北京协和医院肾内科,北京100730

出　　处：《中华肾脏病杂志》2023年第8期616-619,共4页Chinese Journal of Nephrology

基　　金：北京协和医学院教学改革项目(2021zlgc0125);中央高水平医院临床研究业务费项目(2022-PUMCH-A-172)。

摘　　要：该文报道1例仑伐替尼治疗晚期原发性肝癌导致的肾损害。患者为63岁男性,因"肝癌4年,血压升高近2年,水肿7个月"入院。阿特珠单抗联合仑伐替尼治疗肝癌过程中,血压升高及肾功能不全进行性加重。肾活检病理光镜提示内皮细胞病变及肾小管间质损害,电镜提示系膜细胞和系膜基质中度增生,系膜区可见较多团块状低电子密度沉积物,内皮下可见少量电子致密物,病理诊断为内皮细胞病(血栓性微血管病)和继发性局灶节段性肾小球硬化症。考虑为仑伐替尼继发肾损伤。予停用仑伐替尼并给予血管紧张素受体拮抗剂治疗后,门诊随诊8个月余,血压正常、尿蛋白转阴及肾功能显著改善。The article reported one case of renal damage caused by lenvatinib in the treatment of advanced primary liver cancer.The patient was a 63-year-old male who was admitted to the hospital due to"liver cancer for 4 years,blood pressure elevation for nearly 2 years,and edema for 7 months".During the treatment of liver tumors with atezolizumab combined with lenvatinib,blood pressure increased and renal insufficiency aggravated progressively.Pathological light microscopy of renal biopsy showed endothelial cell lesion and tubulointerstitial damage,and electron microscopy showed moderate proliferation of mesangial cells and deposition of mesangial matrix.There were many agglomerated low-electron density deposits in the mesangial area,and a small amount of electron dense deposits in the subendothelium.The pathological diagnosis was endothelial cell disease(thrombotic microangiopathy)and secondary focal segmental glomerulosclerosis.Renal injury was considered as secondary to lenvatinib.After discontinuing lenvatinib and giving angiotensin receptor antagonist treatment,blood pressure was normal,urine protein turned negative,and renal function improved significantly after 8 months of outpatient follow-up.

关 键 词：抗肿瘤药 癌 肝细胞 肾疾病 仑伐替尼 

分 类 号：R969[医药卫生—药理学]