Kidney Week

Abstract: TH-PO1155

Reversible Kidney Impairment Secondary to Lenalidomide-Associated Thyroid Dysfunction: A Case Report

Session Information

• Onconephrology: Emerging Biomarkers, Preclinical Models, Clinical Challenges, and Therapeutic Strategies
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Han, Hui Chuen, Singapore General Hospital, Singapore, Singapore

Hui Chuen Han, MBBS

• Mohan, Kathiravan, Singapore General Hospital, Singapore, Singapore

Kathiravan Mohan, MBBS

• Chen, Yunxin, Singapore General Hospital, Singapore, Singapore

Yunxin Chen, MBBS

• Tan, Hui Zhuan, Singapore General Hospital, Singapore, Singapore

Hui Zhuan Tan, MBBS

Introduction

Thyroid dysfunction is a recognised adverse effect of Lenalidomide therapy¹. Although hypothyroidism is known to contribute to kidney dysfunction, acute kidney disease (AKD) in patients with multiple myeloma (MM) treated with Lenalidomide is often attributed to underlying disease or treatment-related toxicity. As a result, the potential contribution of hypothyroidism to the development of AKD may be under-recognized. We present a case of rapidly reversible AKD following treatment of likely Lenalidomide-associated hypothyroidism.

Case Description

An 83-year-old Chinese man with a background of MM treated with Lenalidomide for the past 2 years presented with AKD noted during his routine haematology review (baseline sCr 121µmol/L > peak sCr 209µmol/L). This was associated with low grade proteinuria (uPCR 0.21g/g) and hematuria (5 RBC/µL). Notably, MM disease activity was assessed to be stable. Limited screen for a glomerular cause was unremarkable (normal C3 and C4 levels; negative anti-myeloperoxidase and anti-proteinase 3). Structural causes were excluded. Thyroid evaluation performed in view of constipation and mild peripheral edema revealed significant hypothyroidism (Thyroid Stimulating Hormone 138mU/L; free Thyroxine 4 <3.2pmol/L). A decision was made to treat the hypothyroidism prior to pursuing kidney biopsy. Prompt levothyroxine replacement resulted in rapid improvement of his kidney dysfunction and an eventual return to his baseline within 3 months (sCr 131µmol/L).

Discussion

Lenalidomide-induced hypothyroidism is a recognised adverse effect with important systemic implications¹. Hypothyroidism can reduce renal perfusion and glomerular filtration, leading to a reversible decline in kidney function². In patients receiving Lenalidomide, AKD may represent unrecognised hypothyroidism rather than intrinsic renal disease, particularly when MM is well controlled and urine investigations are unremarkable. Awareness of this differential may help prevent unnecessary investigations, including kidney biopsy. Thyroid function should be assessed in patients who develop unexplained AKD on Lenalidomide, and periodic thyroid evaluation should be encouraged during treatment to enable early detection of this reversible cause.

1. Figaro MK et. al. Am J Hematol. 2011 Jun;86(6):467-70. doi: 10.1002/ajh.22008.
2. Mariani LH et al. J Am Soc Nephrol. 2012 Jan;23(1):22-6. doi: 10.1681/ASN.2010070766.