ホシノ　ジユンイチ   HOSHINO Junichi   星野　純一    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Glomerular Microangiopathy with Cellular Crescent-like Formation and Endotheliopathy Due to Ramucirumab Treatment for Metastatic Sigmoid Colon Cancer.
掲載誌名	正式名：Internal medicine (Tokyo, Japan) 略　 称：Intern Med ISSNコード：13497235/09182918
巻・号・頁	61(23),pp.3547-3552
著者・共著者	Yoshimura Yusuke, Sawa Naoki, Matsuoka Shusaku, Ikuma Daisuke, Oba Yuki, Sekine Akinari, Hasegawa Eiko, Mizuno Hiroki, Yamanouchi Masayuki, Suwabe Tatsuya, Hoshino Junichi, Kono Kei, Kinowaki Keiichi, Ohashi Kenichi, Toda Shigeo, Matoba Shuichiro, Wakui Hideki, Ubara Yoshifumi
発行年月	2022/12
概要	We encountered a 77-year-old Japanese man who presented with nephrotic-range proteinuria 20 days after receiving ramucirumab treatment for metastatic sigmoid colon cancer. A kidney biopsy showed two characteristic histological findings. The first finding was podocyte injury with cellular crescent-like formation, although focal segmental glomerulosclerosis (FSGS) (collapsing variant) according to the Columbia classification may have been a more appropriate name for this injury, as hypertrophy and hyperplasia of epithelial cells, presumably resulting from podocyte injury, were seen between Bowman's capsule and the glomerular basement membrane (GBM); these changes appeared to be due to the collapse of the GBM rather than to GBM destruction with fibrinoid necrosis. The second finding was endotheliopathy characterized by prominent mesangial interposition via enlargement of the mesangial matrix with mesangiolysis. Proteinuria and renal dysfunction subsided after discontinuation of ramucirumab. Bevacizumab has been reported to induce glomerular microangiopathy with endothelial damage and swelling six months after treatment, but in this case, ramucirumab may have induced focal segmental glomerulosclerosis (FSGS) collapsing variant and glomerular microangiopathy with endotheliopathy via mesangial damage within 1 month. We believe that the damage to the glomerular podocyte and endothelial cells via mesangial damage secondary to ramucirumab in our patient was a different type of glomerular microangiopathy than the endothelial cell damage with enlargement of the subendothelial space caused by bevacizumab.
DOI	10.2169/internalmedicine.9185-21
PMID	35569979