Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy
The emergence of pegylated liposomal doxorubicin (PLD) as a preferred treatment for various malignancies, because of its reduced cardiotoxicity compared with conventional doxorubicin, has raised significant interest. However, the association between PLD and thrombotic microangiopathy (TMA) remains a...
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Elsevier
2025-05-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059525000342 |
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| author | Tarek S. Karam Mrinalini Sarkar Jonathan E. Zuckerman |
| author_facet | Tarek S. Karam Mrinalini Sarkar Jonathan E. Zuckerman |
| author_sort | Tarek S. Karam |
| collection | DOAJ |
| description | The emergence of pegylated liposomal doxorubicin (PLD) as a preferred treatment for various malignancies, because of its reduced cardiotoxicity compared with conventional doxorubicin, has raised significant interest. However, the association between PLD and thrombotic microangiopathy (TMA) remains a concerning and relatively rare complication. Here, we present the case of an 80-year-old man with metastatic Kaposi sarcoma who underwent extended PLD monotherapy, subsequently developing kidney-limited TMA demonstrated on kidney biopsy. This led to acute kidney injury necessitating hemodialysis. The patient’s clinical history, laboratory, and kidney biopsy data supported PLD chemotherapy as the primary etiologic factor for the observed kidney-limited TMA, an insidious condition with poor prognosis. This report highlights the need for vigilance and early kidney biopsy in patients with rising serum creatinine concentrations or worsening proteinuria/hematuria during PLD therapy. Understanding the mechanisms underlying PLD-induced TMA, likely involving reactive oxygen species-mediated endothelial dysfunction and platelet aggregation, remains a crucial area for future research to optimize monitoring and management strategies for this rare yet severe complication associated with PLD therapy. |
| format | Article |
| id | doaj-art-41cf151b0826403fb91c68f2a5d9eb79 |
| institution | OA Journals |
| issn | 2590-0595 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj-art-41cf151b0826403fb91c68f2a5d9eb792025-08-20T02:24:59ZengElsevierKidney Medicine2590-05952025-05-017510099810.1016/j.xkme.2025.100998Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic MicroangiopathyTarek S. Karam0Mrinalini Sarkar1Jonathan E. Zuckerman2Department of Nephrology, University of California, Los Angeles Medical Center, Los Angeles, CA; Address for Correspondence: Tarek S. Karam, MD, University of California, Los Angeles Division of Nephrology, Factor Building 7-155, 700 Tiverton Drive, Los Angeles, CA 90095.Department of Nephrology, University of California, Los Angeles Medical Center, Los Angeles, CADepartment of Pathology and Laboratory Medicine, University of California, Los Angeles Medical Center, Los Angeles, CAThe emergence of pegylated liposomal doxorubicin (PLD) as a preferred treatment for various malignancies, because of its reduced cardiotoxicity compared with conventional doxorubicin, has raised significant interest. However, the association between PLD and thrombotic microangiopathy (TMA) remains a concerning and relatively rare complication. Here, we present the case of an 80-year-old man with metastatic Kaposi sarcoma who underwent extended PLD monotherapy, subsequently developing kidney-limited TMA demonstrated on kidney biopsy. This led to acute kidney injury necessitating hemodialysis. The patient’s clinical history, laboratory, and kidney biopsy data supported PLD chemotherapy as the primary etiologic factor for the observed kidney-limited TMA, an insidious condition with poor prognosis. This report highlights the need for vigilance and early kidney biopsy in patients with rising serum creatinine concentrations or worsening proteinuria/hematuria during PLD therapy. Understanding the mechanisms underlying PLD-induced TMA, likely involving reactive oxygen species-mediated endothelial dysfunction and platelet aggregation, remains a crucial area for future research to optimize monitoring and management strategies for this rare yet severe complication associated with PLD therapy.http://www.sciencedirect.com/science/article/pii/S2590059525000342Doxilkidney biopsyonconephrologypegylated liposomal doxorubicinthrombotic microangiopathy (TMA)renal pathology |
| spellingShingle | Tarek S. Karam Mrinalini Sarkar Jonathan E. Zuckerman Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy Kidney Medicine Doxil kidney biopsy onconephrology pegylated liposomal doxorubicin thrombotic microangiopathy (TMA) renal pathology |
| title | Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy |
| title_full | Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy |
| title_fullStr | Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy |
| title_full_unstemmed | Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy |
| title_short | Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy |
| title_sort | acute kidney injury secondary to pegylated liposomal doxorubicin associated renal limited thrombotic microangiopathy |
| topic | Doxil kidney biopsy onconephrology pegylated liposomal doxorubicin thrombotic microangiopathy (TMA) renal pathology |
| url | http://www.sciencedirect.com/science/article/pii/S2590059525000342 |
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