Early detection of renal damage caused by fumaric acid ester therapy by determination of urinary β2-microglobulin

• Published in: British journal of dermatology (1951) Vol. 164; no. 3; pp. 648 - 651
• Main Authors: Häring, N., Sprenger Mähr, H., Mündle, M., Strohal, R., Lhotta, K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2011; Wiley-Blackwell
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - diagnosis; Acute Kidney Injury - urine; Adult; beta 2-Microglobulin - urine; Biological and medical sciences; Biomarkers - urine; Dermatology; Early Diagnosis; Female; Fumarates - adverse effects; Fumarates - therapeutic use; Humans; Kidney Function Tests; Male; Medical sciences; Middle Aged; Psoriasis - complications; Psoriasis - drug therapy; Early stage; Treatment; Dermatology; Kidney; β2-Microglobulin
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2010.10171.x

Summary Background  Fumaric acid esters are considered efficacious and safe drugs for the treatment of psoriasis. Renal damage, caused either by acute renal injury or Fanconi syndrome, is a recognized side‐effect of this therapy. Objectives  To investigate whether the measurement of urinary excretion of β2‐microglobulin, a marker of renal proximal tubular dysfunction, allows early detection of kidney damage before an increase in serum creatinine or significant proteinuria occurs. Methods  Urinary β2‐microglobulin excretion was measured regularly in 23 patients undergoing fumaric acid ester therapy. Results  Urinary β2‐microglobulin remained normal in all 10 male patients. Three (23%) out of 13 female patients experienced an increase in urinary β2‐microglobulin excretion. In two of these patients a sharp increase was observed in association with high doses. One further patient had moderately elevated levels on rather low doses of fumaric acid esters. After discontinuing treatment, urinary β2‐microglobulin levels returned to normal within a few weeks. Conclusion  Determination of urinary β2‐microglobulin possibly allows early detection of renal damage by fumaric acid esters. Female patients seem to be prone to this side‐effect, especially when taking high doses.