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

Seong Uk Lim; Se Ryeon Lee; Seong Rye Seo; Jae Sook Ahn; Yeo Kyeoung Kim; Deok Hwan Yang; Je Jung Lee; Hyeoung Joon Kim

doi:10.5045/kjh.2008.43.3.166

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Lim, Lee, Seo, Ahn, Kim, Yang, Lee, and Kim: All-trans Retinoic Acid-induced Nephrotic-range Proteinuria in a Patient with Acute Promyelocytic Leukemia

Case Report

Korean J Hematol 2008;43(3):166-169.

Published online: 19 September 2008

DOI: https://doi.org/10.5045/kjh.2008.43.3.166

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

Seong Uk Lim, Se Ryeon Lee, Seong Rye Seo, Jae Sook Ahn, Yeo Kyeoung Kim, Deok Hwan Yang, Je Jung Lee, Hyeoung Joon Kim

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea

Correspondence to：Hyeoung Joon Kim, M.D., Ph.D. Department of Hematology/Oncology, Chonnam National University Hwasun Hospital 160, Ilsimri, Hwasun 519-809, Korea Tel: ＋82-61-379-7637, Fax: ＋82-61-379-7628 E-mail: drydh1685@hotmail.com

Received 19 May 2008 Revised 26 August 2008 Accepted 30 August 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Proteinuria, Acute promyelocytic leukemia, All-trans retinoic acid

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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.

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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