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Review
. 2022 Mar 19;23(1):112.
doi: 10.1186/s12882-021-02656-9.

Regorafenib-induced renal-limited thrombotic microangiopathy: a case report and review of literatures

Qinghua Yin  1 , Na Guo  1 , Xueli Zhou  1 , Huan Xu  2 , Song Lei  2 , Ping Fu  1 , Hui Zhong  3
Affiliations
Review

Regorafenib-induced renal-limited thrombotic microangiopathy: a case report and review of literatures

Qinghua Yin et al. BMC Nephrol. .

Abstract

Background: Regorafenib belongs to a sub-group of small-molecule multi-targeted tyrosine kinase inhibitors(TKIs). In various studies with respect to the side-effect of regorafenib, drug-associated proteinuria standardly qualified to be defined as nephrotic syndrome was rarely reported as well as the relation of regorafenib with the occurrence and development of thrombotic microangiopathy (TMA).

Case presentation: In this case report and literature review, we presented a 62-year-old patient receiving regorafenib for metastatic colon cancer, manifesting abundant proteinuria, in which TMA was also diagnosed through renal biopsy. As far as we were concerned, this was the first reported in terms of regorafenib-induced TMA confirmed by renal biopsy.

Conclusion: This case indicates that regorafenib, a kind of TKIs may result in TMA, which is a rare but life-threatening complication of cancer treatment drug. Insights from this case might help physicians diagnose rare forms of TMA and adjust treatment for patients in a timely manner.

Keywords: Case report; Nephrotic syndrome; Regorafenib; Thrombotic microangiopathy (TMA); Tyrosine kinase inhibitors (TKI).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The clinical course of the patient. A Bevacizumab administration during an 8-month period (Jan 2017-Aug 2017). B Regorafenib administration during a 7-month period (Nov 2018-Dec 2018, Mar 2019-Aug 2019)
Fig. 2
Fig. 2
Pathological biopsy of glomerulus showing thrombotic microangiopathy. A Hematoxylin-eosin staining×200. B Periodic Acid–Schiff staining×200. C Masson’s Trichrom staining×200. D Periodic acid silver methenamine stain ×200. Scale bars=50μm
Fig. 3
Fig. 3
Immunofluorescence. Immunofluorescence for immunoglobulin M (A), kappa (B) and lambda (C) deposition in glomerular mesangium and glomerular capillary loops
Fig. 4
Fig. 4
Electron micrograph. Electron microscopy revealed diffuse endothelial thickening with obliterated capillary lumina and subendothelial fluffy materials or fibrin tactoids deposition
See this image and copyright information in PMC

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