Improvement in Dasatinib-Induced Proteinuria after Switching to Nilotinib: A Case Report

Abstract

Tyrosine kinase inhibitors (TKIs), such as imatinib, dasatinib, and nilotinib, have been used to treat chronic myelogenous leukemia (CML). The adverse effects of these TKIs vary according to the site of signaling pathway inhibition. Here, we report a case of dasatinib- induced proteinuria. A 56-year-old Korean woman was diagnosed with CML and treated with dasatinib. However, 3 years later, the patient developed hypertension and microalbuminuria. Losartan was ineffective, so a kidney biopsy was performed, which revealed dasatinib-associated glomerular changes. Subsequently, dasatinib was switched to nilotinib. After 1 month, the spot urine protein/creatinine ratio decreased from 2,985.0 mg/g to 237.8 mg/g. This case of heavy proteinuria developed after long-term TKI treatment and improved rapidly after switching to another TKI. The proposed strategy is important because it eliminates the need to discontinue the medication or use immunosuppressive drugs to treat proteinuria.