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BRAF Signaling Pathway Inhibition, Podocyte Injury, and Nephrotic Syndrome.

Luca Perico1, Mario Mandalà2, Arrigo Schieppati3

  • 1IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|March 1, 2017
PubMed
Summary
This summary is machine-generated.

Dabrafenib and trametinib, used for metastatic melanoma, can cause nephrotic syndrome, a rare kidney injury. Prompt drug withdrawal and monitoring are crucial for patients undergoing this targeted therapy.

Keywords:
BRAF inhibitorBRAF signaling pathwayDabrafenibMEK inhibitorPLCε1case reportglomerulopathymelanomanephrotic syndromenephrotoxicitypodocyte injuryproteinuriarenal biopsytargeted cancer therapytrametinib

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Area of Science:

  • Oncology
  • Nephrology
  • Pharmacology

Background:

  • Dabrafenib and trametinib are targeted therapies for metastatic melanoma.
  • Their nephrotoxicity is not well-characterized, with tubulointerstitial injury being the most common renal side effect.
  • Nephrotic syndrome has not been previously reported with these agents.

Observation:

  • A patient with metastatic melanoma developed nephrotic syndrome during treatment with dabrafenib and trametinib.
  • Kidney biopsy revealed diffuse podocyte injury, foot-process effacement, and glomerular endothelial damage.
  • Renal function and ultrastructural changes improved after discontinuing the medications.

Findings:

  • BRAF inhibition in vitro reduced podocyte PLCε1 and nephrin expression, increasing albumin permeability.
  • These targeted therapies inhibited the podocyte-VEGF system.
  • The study identified a novel mechanism for drug-induced nephrotic syndrome.

Implications:

  • This case highlights a previously unreported renal side effect of dabrafenib and trametinib.
  • Understanding the mechanism involving podocyte injury and VEGF inhibition is crucial for nephrotic syndrome pathophysiology.
  • Close monitoring for glomerular damage is recommended for patients receiving these melanoma therapies.