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

Br J Dermatol. 2011 Mar;164(3):648-51. doi: 10.1111/j.1365-2133.2010.10171.x. Epub 2011 Feb 3.

Abstract

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.

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / urine
  • Adult
  • Biomarkers / urine
  • Early Diagnosis
  • Female
  • Fumarates / adverse effects*
  • Fumarates / therapeutic use
  • Humans
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Psoriasis / complications
  • Psoriasis / drug therapy
  • beta 2-Microglobulin / urine*

Substances

  • Biomarkers
  • Fumarates
  • beta 2-Microglobulin
  • fumaric acid