Acute renal failure and renal tubular squamous metaplasia following treatment with streptozotocin

• Published in: Human pathology Vol. 13; no. 6; pp. 597 - 601
• Main Authors: Hall-Craggs, Mary, Brenner, Dean E., Vigorito, Robert D., Sutherland, John C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.1982
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - pathology; Adenoma, Islet Cell - drug therapy; Humans; Kidney Tubules - pathology; Kidney Tubules - ultrastructure; Male; Metaplasia; Middle Aged; Pancreatic Neoplasms - drug therapy; Streptozocin - adverse effects; Streptozocin - therapeutic use
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/S0046-8177(82)80280-3

Nephrotoxicity, in the form of transient proteinuria, azotemia, abnormalities of tubular function, and acute renal failure, is the major toxic condition following administration of streptozotocin. The renal morphologic and ultrastructural abnormalities associated with streptozotocin remain poorly defined. We describe a patient with metastatic islet cell tumor of the pancreas who was treated with 16 weekly courses of 1 g/m 2 of streptozotocin without marked change in renal function. Following a six-week hiatus without change in renal function, a single course of 1 g/m 2 of streptozotocin was administered and resulted in acute renal failure. Light microscopic examination of the kidneys showed irregularly dilated renal tubules lined by low cuboid epithelium. The cells were pleomorphic and showed some mitoses. Nuclei were irregular and variably hyperchromatic. Electron microscopic examination disclosed large aggregates of fine microfilaments in the proximal convoluted tubules and collecting ducts. Microfilament aggregates were both free in the cytoplasm and membrane bound. Microfilaments were proved to be tonofilaments by the demonstration of keratin within the epithelium, using the immunoperoxidase method. These data suggest that squamous metaplasia may be an important part of streptozotocin renal toxicity, and the suggestion is made that they may be an antecedent of neoplastic change.