A Case of Dasatinib Induced Nephrotic Syndrome in a Chronic Myeloid Leukemia Patient with Steroid Dependent Nephrotic Syndrome

Tyrosine kinase (TK) inhibitors are most common used to treat chronic myeloid leukemia (CML). Several studies describe a range of adverse effects of TK inhibitors on the kidney in adult patients, including nephrotic syndrome. However, there are only a few pediatric case reports on TK inhibitor-associated nephrotic syndrome. We report a case of nephrotic syndrome associated with dasatinib, a type of TK inhibitor, in a child who suffered from both the underlying idiopathic nephrotic syndrome and CML. A 14-year-old Korean boy was diagnosed with steroid dependent nephrotic syndrome at 4 years old and CML at 11 years old. He developed a relapse of nephrotic syndrome after treatment with TK inhibitors, especially dasatinib, which he used for four months. Despite receiving steroid pulse therapy due to his underlying steroid dependent nephrotic syndrome, his proteinuria did not respond. He discontinued dasatinib medication due to the possibility to dasatinib induced nephrotic syndrome. After one week, his nephrotic syndrome improved. The case is important because if a CML patient that has been on a TK inhibitor develops a newly onset nephrotic range proteinuria, TK inhibitor-induced nephrotic syndrome should be included in the differential diagnosis.