Le lénalidomide est un médicament immunomodulateur très souvent utilisé dans le traitement du myélome multiple. Plusieurs cas de néphrotoxicité ont été rapportés, mais peu ont été documentés ...histologiquement.
Nous rapportons un cas de néphrite interstitielle aiguë au lénalidomide chez un patient âgé de 62 ans atteint de myélome multiple, après l’administration de la seconde cure de chimiothérapie selon le protocole associant bortézomib, lénalidomide et déxaméthasone. L’évolution a été rapidement favorable après l’arrêt du lénalidomide et l’introduction d’une corticothérapie.
Le lénalidomide peut être responsable de néphrite interstitielle aiguë. Devant une insuffisance rénale aiguë au cours du traitement du myélome multiple, la néphrotoxicité des agents thérapeutiques doit également être évoquée en plus des causes d’atteintes rénales classiques. La chronologie des faits et les données histologiques sont essentielles et guident la prise en charge spécifique.
Lenalidomide is an immunomodulatory drug widely used in the treatment of multiple myeloma. Several cases of nephrotoxicity have been reported, but few have been documented histologically.
We report a case of acute interstitial nephritis to lenalidomide in a 62-year-old patient with multiple myeloma after administration of the second course of chemotherapy according to the protocol combining bortezomib, lenalidomide and dexamethasone. The outcome was quickly favorable after stopping lenalidomide, with corticosteroid therapy.
Lenalidomide may be responsible for acute interstitial nephritis. When acute kidney injury occurs in myeloma, the nephrotoxicity of therapeutic agents should be considered in addition to the common causes of kidney failure. The chronology of events and the histological data are essential and guide the specific management.
Bee sting venom is generally well tolerated. However, some rare cases of massive stings can lead to anaphylactic shock and even renal failure. This observation is the illustration of a case of acute ...kidney injury secondary to bee stings in a 64-year-old black african subject.
A 64-year-old man without a known medical history was referred to the emergency department of the Fousseyni Daou hospital in Kayes (Mali) for disturbed consciousness 4 hours after massive stings from a bee swarm. Renal failure with serum creatinine level at 752,2 µmol/L was documented on day 3 in a context of total anuria. The patient was transferred to a nephrology unit and biology confirmed renal failure associated with intravascular haemolysis and rhabdomyolysis. The kidneys were of normal size and well differentiated. The diagnosis of severe acute kidney injury due to massive envenomation induced by bee venom was evoked. The evolution was favourable, with normalization of renal function at D26 after 5 sessions of haemodialysis in parallel with transfusions of packed red blood cells.
A massive bee attack should be considered a medical emergency because of the organic damage it can inflict. The renal prognosis depends on the number of stings, and especially on the delay and the quality of the treatment. Early initiation of dialysis treatment reduces mortality.
Bee sting venom is generally well tolerated. However, some rare cases of massive stings can lead to anaphylactic shock and even renal failure. This observation is the illustration of a case of acute ...kidney injury secondary to bee stings in a 64-year-old black african subject.
A 64-year-old man without a known medical history was referred to the emergency department of the Fousseyni Daou hospital in Kayes (Mali) for disturbed consciousness 4 hours after massive stings from a bee swarm. Renal failure with serum creatinine level at 752,2 μmol/L was documented on day 3 in a context of total anuria. The patient was transferred to a nephrology unit and biology confirmed renal failure associated with intravascular haemolysis and rhabdomyolysis. The kidneys were of normal size and well differentiated. The diagnosis of severe acute kidney injury due to massive envenomation induced by bee venom was evoked. The evolution was favourable, with normalization of renal function at D26 after 5 sessions of haemodialysis in parallel with transfusions of packed red blood cells.
A massive bee attack should be considered a medical emergency because of the organic damage it can inflict. The renal prognosis depends on the number of stings, and especially on the delay and the quality of the treatment. Early initiation of dialysis treatment reduces mortality.
Introduction: Multiple myeloma (MM) is a monoclonal proliferation of mature plasma cells. It usually occurs in people over 50 years of age with a peak in frequency at 65 years of age and less than 2% ...of patients are under 40 years of age. Case presentation: This case report is of a 38 year old black African woman with chronic kidney disease stage 5D. The IR was of glomerular origin (hypertension for 2 years, proteinuria at 4 g/24 hours, oedematous syndrome). Serum protein electrophoresis showed a beta peak at 29.7 g/l and urine protein immunoelectrophoresis showed a kappa/lambda ratio of 8.4. The myelogram showed a rich marrow with 51% plasma cells. Radiography showed multiple cystic images at the upper 1/3 of the left humeral shaft. Renal histology showed minimal glomerular damage. The diagnostic profile of IgG kappa light chain MM with CRAB criteria complicated by chronic glomerulonephritis with unorganised monoclonal immunoglobulin deposits was suggested. Management consisted of chemotherapy with bortezomib and dexamethasone for 4 cycles. The evolution under chronic dialysis was favourable after 1 year. Conclusion: MM in young adults (defined as 19-40 years of age) is rare, but it does exist. In young patients, this condition is initially not considered in the differential diagnosis and the occurrence of IR has a strong prognostic impact. Survival seems to be better in young adults than in elderly patients, which needs to be proven by a longer follow-up.
INTRODUCTIONLenalidomide is an immunomodulatory drug widely used in the treatment of multiple myeloma. Several cases of nephrotoxicity have been reported, but few have been documented histologically. ...CASE PRESENTATIONWe report a case of acute interstitial nephritis to lenalidomide in a 62-year-old patient with multiple myeloma after administration of the second course of chemotherapy according to the protocol combining bortezomib, lenalidomide and dexamethasone. The outcome was quickly favorable after stopping lenalidomide, with corticosteroid therapy. CONCLUSIONLenalidomide may be responsible for acute interstitial nephritis. When acute kidney injury occurs in myeloma, the nephrotoxicity of therapeutic agents should be considered in addition to the common causes of kidney failure. The chronology of events and the histological data are essential and guide the specific management.