Pegylated Liposomal Doxorubicin Causes Kidney-limited Thrombotic Microangiopathy.

A definite causal link between pegylated liposomal doxorubicin (PLD) and kidney-limited thrombotic microangiopathy (TMA) remains unestablished. Here, we report 2 cases of PLD-induced kidney-limited TMA, 1 in a patient with myxofibrosarcoma and the other in a patient with liposarcoma. The 2 patients received a high cumulative dose of PLD, and both presented with a rise in serum creatinine and proteinuria. Kidney biopsy revealed TMA with chronic mesangiolysis and capillary wall double contouring. Neither patient had concomitant exposure to TMA-causing drugs, such as gemcitabine, anti-vascular endothelial growth factor agents, or mammalian target of rapamycin inhibitors. The work-up for secondary causes of TMA was negative in both patients. The cessation of PLD therapy led to improvement or stabilization in serum creatinine and proteinuria in both patients. These 2 cases provide a clear causal link between PLD and kidney-limited TMA. The high cumulative dose of PLD increases the risk of kidney TMA. Early recognition of PLD-induced kidney TMA can lead to timely cessation of PLD therapy and potentially preserve kidney function. Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Citation

Ilya Glezerman, Steven Salvatore, William Tap, Ciara Kelly, Claudia Michelle Brauer Ornelas, Aisha Shaikh. Pegylated Liposomal Doxorubicin Causes Kidney-limited Thrombotic Microangiopathy. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2024 Apr;83(4):549-553

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PMID: 37839689

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