Saudi Journal of Kidney Diseases and Transplantation

CASE REPORT
Year
: 2019  |  Volume : 30  |  Issue : 4  |  Page : 989--994

Everolimus worsening chronic proteinuria in patient with diabetic nephropathy post liver transplantation


Ramy M Hanna1, Beshoy Yanny2, Farid Arman1, Marina Barsoum1, Mira Mikhail1, Maha Al Baghdadi1, Anjay Rastogi1, William Wallace3, Sammy Saab4 
1 Department of Medicine, Division of Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
2 Department of Medicine, Division of Digestive Disease, Hepatology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
3 Department of Pathology, Division of Renal Pathology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
4 Department of Medicine, Division of Digestive Disease, Hepatology, University of California Los Angeles David Geffen School of Medicine; Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA

Correspondence Address:
Ramy M Hanna
Department of Medicine, Division of Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095
USA

Mammalian target of rapamycin (mTOR) inhibitors are used in renal sparing protocols and transplant immunosuppression in patients with solid organ and stem cell transplants. They cause various side effects, including proteinuria, which is mediated by blockade of the vascular endothelial growth factor receptor pathway. There have been various reports of mTOR inhibitors causing proteinuria or worsening proteinuria form preexisting renal glomerulo-pathies. We report a 73-year old male with diabetic glomerulosclerosis, acute liver failure due to Budd-Chiari syndrome, chronic low platelets, and worsening proteinuria from 0.46 g protein/g creatinine to 2.2 g protein/g creatinine. Workup revealed no thrombotic microangiopathy through skin biopsy, and a renal biopsy confirmed only clinically suspected diabetic and hypertensive glomerulosclerosis and possible calcineurin inhibitors. On discontinuation of everolimus urine protein decreased back to 0.6 g/g creatinine. We review the mechanism of mTOR-induced proteinuria and how this may affect diabetic nephropathy secondarily. We also consider the clinical implications of this in transplant patients receiving these agents.


How to cite this article:
Hanna RM, Yanny B, Arman F, Barsoum M, Mikhail M, Al Baghdadi M, Rastogi A, Wallace W, Saab S. Everolimus worsening chronic proteinuria in patient with diabetic nephropathy post liver transplantation.Saudi J Kidney Dis Transpl 2019;30:989-994


How to cite this URL:
Hanna RM, Yanny B, Arman F, Barsoum M, Mikhail M, Al Baghdadi M, Rastogi A, Wallace W, Saab S. Everolimus worsening chronic proteinuria in patient with diabetic nephropathy post liver transplantation. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Dec 11 ];30:989-994
Available from: http://www.sjkdt.org/article.asp?issn=1319-2442;year=2019;volume=30;issue=4;spage=989;epage=994;aulast=Hanna;type=0