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Abstract

Clinical Nephrology, Vol. 87 – No. 1/2017 (51-54)

Thrombotic microangiopathy associated with cetuximab, an epidermal growth factor receptor inhibitor 

Mitsuteru Koizumi, Masahiro Takahashi, Maki Murata, Yuko Kikuchi, Koichi Seta, Kensei Yahata 

Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
Cetuximab is a chimeric human-murine monoclonal antibody that binds competitively and with high affinity to the epidermal growth factor receptor (EGFR) and is used to treat advanced squamous cell carcinoma of the head and neck. After receiving a total of six doses of cetuximab, a 72-year-old male presented with pretibial edema, acne-like skin rash, and nephrotic syndrome. The renal biopsy findings revealed features of thrombotic microangiopathy (TMA), with the expansion of the subendothelial zone, reduplication of the glomerular basement, and swelling of the endothelial cells. Nine weeks after the discontinuation of cetuximab, his pretibial edema had disappeared and proteinuria decreased. To our knowledge, this is the first report in which kidney biopsy revealed evidence of TMA due to cetuximab administration. Our report suggests that it may be prudent to monitor patients receiving cetuximab closely for the possible development of nephrotic syndrome. Correspondence to:
Mitsuteru Koizumi, MD
Department of Nephrology
National Hospital Organization Kyoto Medical Center
1-1 Fukakusa,  Mukaihata-cho, Fushimi-ku,
Kyoto 612-8555, Japan 
Email: mit-koiz@ rb4.so-net.ne.jp

Abstract

Clinical Nephrology, Vol. 89 – No. 2/2018 (123-129)

Membranoproliferative glomerulonephritis with unusual deposits of parallel arrangement striated structure: a new pathological entity? 

Kensei Yahata¹, Yuko Kikuchi¹, Mitsuteru Koizumi¹, Koichi Seta¹, Hideki Wakui², Atsushi Komatsuda³, and Akira Shimizu⁴ 

¹Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, ²Department of Life Science, Akita University Graduate School of Engineering Science, Akita, ³Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, and ⁴Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
A 71-year-old male with a past history of lower limb arteriosclerosis obliterans developed nephrotic syndrome and renal dysfunction. Renal biopsy showed diffuse global endocapillary proliferative lesions with infiltration of mononuclear cells and occasional foam cells. An irregular double contour of the glomerular basement membrane and global mild-to-moderate mesangial proliferative lesions were observed, indicating membranoproliferative glomerulonephritis. Congo red staining was negative. Routine immunofluorescence studies showed no obvious immunoglobulin or complement depositions. Electron microscopy showed endocapillary proliferative lesions and infiltration of macrophages with abundant lysosomes. Irregular subepithelial, subendothelial, and mesangial electron-dense deposits were observed in glomeruli. In these electron-dense deposits, parallel arrangement striated structures were detected. All known disease entities with Congo red-negative and immunoglobulin-negative glomerular deposits were pathologically excluded. The glomerular lesion in our case might be a new disease entity. Correspondence to:
Kensei Yahata, MD
 Department of Nephrology
National Hospital Organization Kyoto Medical Center
1-1 Fukakusa Mukaihata-cho, Fushimi-ku,
Kyoto 612-8555, Japan 
Email: kenseiyahata@ yahoo.co.jp

Abstract

Clinical Nephrology, Vol. 90 – No. 5/2018 (357-362)

Idiopathic immune complex-mediated tubulointerstitial nephritis with hypocomplementemia and neutrophil-rich interstitial infiltrates 

Haruka Ikuta¹, Jaegi Shim¹, Masahiro Takahashi¹, Mitsuteru Koizumi¹, Koichi Seta¹, Shigeo Hara², and Kensei Yahata¹

¹Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, and ²Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Hyogo, Japan
A 69-year-old man presented with acute kidney injury, hypocomplementemia, antinuclear antibody, and anti-dsDNA antibody. He had no signs of systemic lupus erythematosus or Sjögren syndrome. He had not begun taking any new drugs in the preceding 6 months. Kidney biopsy revealed 13 glomeruli, 3 with global sclerosis. The remaining glomeruli showed slight mesangial proliferation. The interstitial inflammation was extensive, comprising mainly mature lymphocytes and plasma cells, neutrophils, and a few eosinophils. Remarkable granular and diffuse deposition of IgG and C1q was observed along the tubular basement membranes. Electron microscopy showed electron-dense deposits in the tubular basement membrane. Immunohistochemistry showed only 1 – 4 IgG4-positive plasma cells per high-power field and an IgG4/CD138 ratio of ~ 10%. He was treated with oral prednisolone 35 mg/day, and his kidney function gradually improved. This is a unique case that is not consistent with any known disease entities with immune complex-mediated tubulointerstitial nephritis. Correspondence to:
Kensei Yahata, MD
Department of Nephrology
National Hospital Organization Kyoto Medical Center
1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan 
Email: kenseiyahata@ yahoo.co.jp

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