{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:44:46Z","timestamp":1756385086614,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,4]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>Tyrosine kinase inhibitors (TKI) are anticancer agents widely used for a variety of malignancies including gastrointestinal stromal tumours (GIST). Although generally well-tolerated, TKIs have been associated with a number of adverse events including hypertension, proteinuria and nephrotic syndrome. We present the case of a 70-year-old patient with metastatic GIST on long-standing sunitinib who developed hypertension, oedema and hypoalbuminemia with a rising serum creatinine and was found to have nephrotic syndrome. Workup revealed elevated antiphospholipase A2 receptor (PLA2R) antibody IgG titres and a kidney biopsy confirmed PLA2R-positive membranous nephropathy without findings of thrombotic microangiopathy. Cessation of sunitinib led to reduction in anti-PLA2R antibody IgG titres while resumption, due to concern for cancer progression, led to worsening symptoms. Treatment with rituximab led to undetectable anti-PLA2R IgG titres. We highlight the importance of maintaining a systematic approach for evaluating nephrotic syndrome and provide a case showing that TKIs can exacerbate underlying nephrotic syndrome.<\/jats:p>","DOI":"10.1136\/bcr-2021-243567","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T13:00:41Z","timestamp":1628686841000},"page":"e243567","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Worsening membranous nephropathy in a patient with GIST treated with sunitinib"],"prefix":"10.1136","volume":"14","author":[{"given":"Shahrzad","family":"Zonoozi","sequence":"first","affiliation":[{"name":"Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teitelbaum","family":"Ursina","sequence":"additional","affiliation":[{"name":"Department of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdallah","family":"Geara","sequence":"additional","affiliation":[{"name":"Department of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,11]]},"reference":[{"key":"2025082709354631000_14.8.e243567.1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2011.288"},{"key":"2025082709354631000_14.8.e243567.2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.C300012200"},{"key":"2025082709354631000_14.8.e243567.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021491"},{"key":"2025082709354631000_14.8.e243567.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2009.11.001"},{"key":"2025082709354631000_14.8.e243567.5","doi-asserted-by":"publisher","DOI":"10.1159\/000319885"},{"key":"2025082709354631000_14.8.e243567.6","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn657"},{"key":"2025082709354631000_14.8.e243567.7","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-201183"},{"key":"2025082709354631000_14.8.e243567.8","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-011-0543-9"},{"key":"2025082709354631000_14.8.e243567.9","doi-asserted-by":"publisher","DOI":"10.1159\/000241551"},{"key":"2025082709354631000_14.8.e243567.10","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfp666"},{"key":"2025082709354631000_14.8.e243567.11","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn625"},{"key":"2025082709354631000_14.8.e243567.12","doi-asserted-by":"publisher","DOI":"10.4103\/0971-4065.107215"},{"key":"2025082709354631000_14.8.e243567.13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s13730-014-0135-0","article-title":"A case of gefitinib-associated membranous nephropathy in treatment for pulmonary adenocarcinoma","volume":"4","author":"Kaneko","year":"2015","journal-title":"CEN Case Rep"},{"key":"2025082709354631000_14.8.e243567.14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/ki.2015.29","article-title":"Correlation of disease activity in proliferative glomerulonephritis with glomerular spleen tyrosine kinase expression","volume":"88","author":"McAdoo","year":"2015","journal-title":"Kidney Int"},{"key":"2025082709354631000_14.8.e243567.15","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2012.484"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-243567","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:35:54Z","timestamp":1756312554000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-243567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":15,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,11]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-243567"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-243567","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}