AUTHOR=Abdelhakeem Ahmed , Baker Lyle , Amin Md. Shahrier , Babiker Hani , Aslam Nabeel , Majeed Umair 

TITLE=Case Report: Gemcitabine-induced membranoproliferative glomerulonephritis with immune complexes in a patient with metastatic pancreatic cancer

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1666859

DOI=10.3389/fmed.2025.1666859

ISSN=2296-858X

ABSTRACT=Gemcitabine is a widely used chemotherapeutic agent for pancreatic adenocarcinoma, that is associated with rare but serious renal complications including thrombotic microangiopathy (TMA). We report a unique case of biopsy-proven membranoproliferative glomerulonephritis (MPGN) with immune complex deposition in a woman receiving gemcitabine for metastatic pancreatic cancer. She developed new-onset hypertension, proteinuria, microscopic hematuria, and progressive renal dysfunction shortly following initiation of gemcitabine. Extensive autoimmune, complement, paraprotein, and viral serologies were unremarkable aside from a low haptoglobin. Kidney biopsy revealed an MPGN pattern with immune deposits. Gemcitabine was discontinued, and the patient was treated with corticosteroids and kidney-protective therapies targeting blood pressure and proteinuria reduction. Her proteinuria decreased significantly, and her renal function returned back to baseline. This case highlights a rare manifestation of gemcitabine-induced nephrotoxicity with immune complex MPGN, suggesting a possible novel mechanism of drug-associated glomerular injury.