Crescentic transformation induced by granulocyte-colony stimulating factor administration – a case report and review of literature

Abstract

The use of recombinant human granulocyte-colony stimulating factor (G-CSF) is a less commonly discussed aetiology for acute kidney injury in cancer patients. Several patterns of renal injury due to G-CSF have been discussed in the literature. Here, we present a case of a 48-year-old man with monoclonal gammopathy of renal significance who received filgrastim for planned autologous stem cell transplantation and developed acute kidney injury presenting as crescentic glomerulonephritis. The patient was treated with steroids, plasmapheresis, and cyclophosphamide. He attained complete recovery and proceeded with stem cell transplantation. We conducted an extensive review of the literature on the subject, which revealed that 10 of the 18 biopsy-proven cases of G-CSF–induced renal injury presented as crescentic glomerulonephritis. When G-CSF is administered to patients with an underlying renal pathology (usually autoimmune or monoclonal in aetiology), the migration and degranulation of activated neutrophils in the glomerular micro-environment in large numbers results in glomerular basement membrane rupture and crescent formation. Timely renal biopsy and aggressive initiation of treatment aid in attaining renal recovery and a favourable prognosis in cancer patients.