Renal failure and recovery associated with second-generation Bcr-Abl kinase inhibitors in imatinib-resistant chronic myelogenous leukemia

Tyrosine kinase inhibitors (TKIs) directed against the Bcr-Abl kinase have revolutionized the treatment of chronic myelogenous leukemia (CML). Relatively little is known regarding the effects of these agents on the kidney. Clinically, there have been a handful of reports associating imatinib with acute renal failure. Preclinical reports indicate that imatinib inhibits signaling pathways which may play a role in renal injury. We report the case of a patient with imatinib-resistant CML who developed renal failure after being placed on dasatinib. When she later became resistant to dasatinib she was switched to nilotinib. Shortly thereafter, she became dialysis-independent. Second-generation Bcr-Abl TKIs may influence renal function based on differential inhibition of related tyrosine kinases.