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Case Reports
. 2017 Aug 6;11(1):214.
doi: 10.1186/s13256-017-1384-2.

Anti-glomerular basement membrane glomerulonephritis following nintedanib for idiopathic pulmonary fibrosis: a case report

Ibrahim Ismail  1 , Sonu Nigam  2 , Alan Parnham  3 , Vinay Srinivasa  3
Affiliations
Case Reports

Anti-glomerular basement membrane glomerulonephritis following nintedanib for idiopathic pulmonary fibrosis: a case report

Ibrahim Ismail et al. J Med Case Rep. .

Abstract

Background: We report a previously unrecognized and unreported case of a patient with anti-glomerular basement membrane glomerulonephritis following nintedanib, an orally active small molecule tyrosine kinase inhibitor.

Case presentation: A 59-year-old Caucasian woman with a history of idiopathic pulmonary fibrosis presented with severe acute kidney injury (creatinine 285 umol/L) secondary to anti-glomerular basement membrane glomerulonephritis disease 4 months after commencement of nintedanib. She had hematuria with red blood cell casts, nephrotic range proteinuria (3.5g/24 hours) and significantly elevated anti-glomerular basement membrane glomerulonephritis titers at 860 chemiluminescent units. A kidney biopsy confirmed severe crescentic glomerulonephritis with linear immunoglobulin G deposition in glomerular basement membrane. Despite the commencement of treatment with plasma exchange and cyclophosphamide, she remained dialysis dependent. Nintedanib was discontinued.

Conclusions: Onset of acute anti-glomerular basement membrane glomerulonephritis was found to be associated with recent nintedanib use suggesting that nintedanib may be a potential trigger for anti-glomerular basement membrane glomerulonephritis. This case highlights the importance of close monitoring of patients receiving new targeted therapies. Management of novel targeted agents in patients receiving dialysis is challenging because of the scarcity of specific data.

Keywords: Anti-GBM disease; Idiopathic pulmonary fibrosis; Nintedanib; Novel targeted therapy.

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Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
High-resolution computed tomography scan showing extensive peripheral, subpleural pulmonary fibrosis, and early honeycombing
Fig. 2
Fig. 2
a-c Linear 3+ reaction along glomerular basement membrane with immunoglobulin G (a), kappa (b), and lambda (c); d glomerulus showing cellular crescents associated with inflammatory infiltrate comprised of neutrophils and macrophages, disruption of Bowman’s capsule and fibrinoid necrosis, and red blood cell casts (hematoxylin and eosin ×200)
See this image and copyright information in PMC

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