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Case Reports
. 2017:2017:7964015.
doi: 10.1155/2017/7964015. Epub 2017 Nov 16.

Cetuximab-Associated Crescentic Diffuse Proliferative Glomerulonephritis

Sukesh Manthri  1 , Sindhura Bandaru  1 , Anthony Chang  2 , Tamer Hudali  1
Affiliations
Case Reports

Cetuximab-Associated Crescentic Diffuse Proliferative Glomerulonephritis

Sukesh Manthri et al. Case Rep Nephrol. 2017.

Abstract

Cetuximab-induced nephrotoxicity is very rare, occurring in less than 1% of colorectal cancer patients and not defined in other populations. We report a rare case of crescentic diffuse proliferative glomerulonephritis (GN) that developed in close temporal association with cetuximab treatment. A 65-year-old female recently completed chemotherapy with cetuximab treatment for moderately differentiated oral squamous cell carcinoma. She was admitted with acute renal failure and nephrotic-range proteinuria. Laboratory data showed serum creatinine of 6.6 mg/dl and urinalysis showed proteinuria, moderate hemoglobinuria, hyaline casts (41/LPF), WBC (28/HPF), and RBC (81/HPF). Serologic studies were negative for ANA, anti-GBM, ANCA, hepatitis B, and hepatitis C. Serum C3 and C4 level were normal. Renal biopsy showed crescentic diffuse proliferative GN with focal features of thrombotic microangiopathy. Patient was started on cyclophosphamide and steroids. Her renal function did not improve on day 8 and she was started on hemodialysis. Previous reports suggest that EGFR-targeting medications can possibly trigger or exacerbate an IgA-mediated glomerular process leading to renal failure. This case suggests that cetuximab therapy may have triggered or exacerbated a severe glomerular injury with an unfavorable outcome. Treating physicians should maintain a high degree of caution and monitor renal function in patients on EGFR inhibitors.

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Figures

Figure 1
Figure 1
This glomerulus demonstrates accentuation of the lobular architecture with associated endocapillary hypercellularity and duplication of the glomerular basement membranes (Jones methenamine silver).
Figure 2
Figure 2
There is granular mesangial and capillary wall immunofluorescence staining for the respective immunoglobulins and complement components that range from 1 to 2+ on a scale of 0–4+.
Figure 3
Figure 3
Figure demonstrating arteriolar thrombotic microangiopathy.
Figure 4
Figure 4
A cellular crescent fills Bowman space adjacent to this glomerulus with prominent endocapillary hypercellularity (Periodic acid-Schiff).
See this image and copyright information in PMC

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