Case Reports in Hepatology

Case Report

Nephrotic Syndrome Induced by Lenvatinib Treatment for Hepatocellular Carcinoma

Table 2

A summary of all 8 patients with lenvatinib-induced renal toxicity published in English literature from 2019 to 2020.


Patient	Gender/age (year)	Race	Cancer	Lenvatinib dose (per day)/duration (month)	Clinical presentations	Renal function: creatinine (mg/dL)/eGFR (mL/min/1.73 m²)	Urinalysis/24-hour protein urine (g)	Renal histological finding	Treatment	Outcome

1, 2018 [23]	F/36	Caucasian	Medullary thyroid carcinoma	24 mg/19	Worsening HT, ankle edema	Normal	NA/3.1 g	FSGS	Discontinued lenvatinib	No proteinuria in 1 year
2, 2018 [23]	F/70	Japan	Papillary thyroid carcinoma	24 mg/26	Worsening HT, legs edema	1.12/37.4	WBC <1, RBC 5–9 cells/HPF/3.5 g	TMA	Decreased dose to 8 mg of lenvatinib and discontinuation	Partial recovery in 2 months
3, 2018 [16]	F/79	Japan	Papillary thyroid carcinoma	10 mg/3	Worsening HT, generalized edema	1.17/34	RBC 20–29 cells/HPF/11.8 g	FSGS	Discontinued lenvatinib	Complete recovery in 15 months
4, 2018 [22]	M/44	Caucasian	Papillary thyroid carcinoma	24 mg/6 20 mg/4 14 mg/26 10 mg/12	Worsening HT	1.90/NA	NA/3.5 g	FSGS, tubulointerstitial vascular necrosis, TMA-like pattern	Decreased dose to 10 mg of lenvatinib and discontinued	Partial recovery in 1 month
5, 2018 [22]	F/59	Caucasian	Adenoid cystic carcinoma of the minor salivary gland	24 mg/15	Acute renal failure (tubulointerstitial nephropathy by clinics)	2.81/NA	No sediment/< 1 g	Not performed	Discontinued lenvatinib. Prednisolone 40 mg taper in 6 months	Renal function improved in 10 days
6, 2018 [24]	M/67	Caucasian	Papillary thyroid carcinoma	24 mg/9	Worsening HT and renal function	2.46/26.0	NA/NA	Not performed	Discontinued lenvatinib	Partial recovery in 8 months
7, 2020 [25]	M/56	Taiwan	Papillary thyroid carcinoma	20 mg/1	Worsening HT, legs edema	0.56/115	Trace hematuria/9.9 g	Not performed	Decreased dose to 10 mg of lenvatinib and discontinued with sorafenib replacement	Partial recovery in 5 months
8 (our case), 2020	F/67	Thai	Hepatocellular carcinoma	8/0.5	Worsening HT, bilateral pleural effusion, legs edema	0.9/66	WBC 0–1, RBC 0–1 cells/HPF/7.01 g	Not performed	Discontinued lenvatinib	Partial recovery in 1 week

FSGS, focal segmental glomerulosclerosis; TMA, thrombotic microangiopathy; HT, hypertension; AEs, adverse events; WBC, white blood cells; RBC, red blood cells; F, female; M, male; NA, not applicable.