达沙替尼致儿童蛋白尿一例

A case of dasatinib-induced adverse reactions in a child with proteinuria

本文报道了1例11岁患儿因慢性粒细胞白血病使用达沙替尼1个月后,尿常规检查异常,出现隐血与尿蛋白持续加重。经医师诊断排除其他病理因素,考虑为达沙替尼的不良反应,临床药师建议停药并给予依那普利对症处理,停药1周后复查尿常规,指标明显改善。后续换用甲磺酸伊马替尼片继续治疗,复查再无蛋白尿出现。结合文献报道,考虑使用达沙替尼后出现大量蛋白尿,可能与抑制了血管内皮细胞生长因子(VEGF)有关,因此提示儿童在使用达沙替尼等酪氨酸激酶抑制剂前应先进行肾功能、尿常规检查,使用中定期复查相关指标,并且应重视用药后的监测和随访工作。

Herein we reported a case of albuminuria in a 11-year-old children caused by dasatinib,the routine examination of urine was abnormal,occult blood and urine protein appeared and continued to worsen.According to the diagnosis of the clinician,other pathological factors were excluded and considered as the adverse reaction of dasatinib.The clinical pharmacist suggested that the drug should be stopped and enalapril should be given symptomatic treatment.After stopping the drug for 1 week,the urine routine test was reviewed,and the indicators were significantly improved.The follow-up treatment was continued with imatinib mesylate tablets,and there was no proteinuria in the reexamination.Based on the literature reports,we considered that albuminuria after using dasatinib may be related to the inhibition of vascular endothelial growth factor(VEGF),which suggests that children should first have renal function and urine routine examination before using dasatinib and other TKIs,and clinicians should regularly review relevant indicators during medication and pay attention to monitoring and follow-up after drug use.