Korean J Hematol.  2008 Sep;43(3):166-169. 10.5045/kjh.2008.43.3.166.

All-trans Retinoic Acid-induced Nephrotic-range Proteinuria in a Patient with Acute Promyelocytic Leukemia

• Lim SU
• Lee SR
• Seo SR
• Ahn JS
• Kim YK
• Yang DH
• Lee JJ
• Kim HJ

• KMID: 2252183
• DOI: http://doi.org/10.5045/kjh.2008.43.3.166

Abstract

All-trans retinoic acid (ATRA) is a potent differentiating agent for the treatment of acute promyelocytic leukemia (APL). Although ATRA is generally well-tolerated, some patients develop side effects, the most severe of which is ATRA syndrome. We report on a patient with APL who developed isolated nephrotic-range proteinuria during ATRA therapy for remission-induction. ATRA was discontinued and the proteinuria decreased significantly 5 days after dexamethasone treatment. The occurrence of isolated proteinuria during ATRA treatment is a rare adverse event.

Keyword

Proteinuria; Acute promyelocytic leukemia; All-trans retinoic acid

MeSH Terms

Dexamethasone
Humans
Leukemia, Promyelocytic, Acute
Proteinuria
Tretinoin
Dexamethasone
Tretinoin

Figure

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  Fig. 1 Cytogenetic and dual color fluorescence in situ hybridization (FISH) analysis. (A) Cytogenetic analysis of the bone marrow showed a t(15;17)(q22;q24) in all metaphases. (B) This translocation between chromosomes 15 and 17 was also detected in 94% of the bone marrow cells by dual color, single fusion method of FISH analysis.

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  Fig. 2 Time sequence of clinical features. Dexamethasone was started on day 15; the 24-hour proteinuria then decreased to 12.5g/day. However, the spot urine protein remained ＞300mg/dL and the ATRA was subsequently discontinued on day 22. The concentration of the 24-hour protein decreased gradually. Dexamethasone was discontinued on day 23.

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