Pamidronate-induced nephrotoxic tubular necrosis  a case report

Smetana, Shmuel; Michlin, A; Rosenman, Eliezer; Biro, Alexander; Boaz, Mona; Katzir, Zeev

doi:10.5414/cnp61063

Cited by 35 publications

(18 citation statements)

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“…The patient's tubulointerstitial damage, which had also been demonstrated by renal biopsy, might have been related to pamidronate-associated glomerular injury, since such lesions often develop if progressive chronic primary glomerular disease resulting in irreversible destruction of nephrons is present [8]. Otherwise, the minor tubular interstitial inflammatory infiltrates and the lack of antibodies in the immunofluorescence analyses may suggest that pamidronate acts as a direct epithelial cell toxin targeting the tubular epithelium [9].…”

Section: Discussionmentioning

confidence: 98%

Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

et al. 2011

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This report presents a case of nephrotic syndrome and renal failure that developed in a 53-year-old female with metastatic breast carcinoma. She was diagnosed to have osteolytic bone metastases 5 years prior to admission, and had been administered pamidronate with a total dose of approximately 6800 mg. A renal biopsy revealed tubulointerstitial damage and marked wrinkling and retraction of the glomerular basement membrane with hypertrophy and hyperplasia of the epithelial cells, compatible with the collapsing form of focal segmental glomerulosclerosis (FSGS). Despite the discontinuation of pamidronate after admission, her renal function gradually decreased. She was finally managed with continuous palliative care for advanced malignancy through a shared effort, and died 96 days after undergoing the renal biopsy. Although the clinical impact of the pamidronate-associated kidney injury on the longitudinal changes in renal function remains to be delineated, it is therefore reasonable to consider that the collapsing FSGS associated with tubulointerstitial damage may have resulted in the irreversible renal injuries that were observed in the current case. Further studies and accumulated experience with renal biopsy are required to better determine the relationship between pathological alterations and prognostic characteristics among patients with pamidronate-associated renal impairments.

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Section: Discussionmentioning

confidence: 98%

Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

et al. 2011

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“…Focal collapsing glomerulosclerosis seems to be the most frequent lesion in adults [17]. However, there are case reports of acute tubular necrosis [18], nephritic-range proteinuria [19] and tubulointerstitial inflammatory nephritis [20]. Such nephrotoxicity has been mainly reported in patients with malignancies.…”

Section: Discussionmentioning

confidence: 99%

Nephronophthisis-like nephritis associated with fibrous dysplasia of bone

et al. 2008

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Nephronophthisis is a chronic tubulointerstitial nephritis with autosomal recessive inheritance whose evolution to end-stage renal disease is insidious but constant. Fibrous dysplasia of bone is characterized by focal replacement of normal bone and marrow with abnormal bone and fibrous tissue. We report on a young boy initially diagnosed with fibrous dysplasia of bone, who underwent renal investigation because of treatment with pamidronate. He presented with mild proteinuria (albuminuria/creatininuria 19 mg/mmol) and decreased glomerular filtration rate (GFR) (79 ml/min per 1.73 m(2) body surface area) leading to kidney biopsy, which showed nephronophthisis-like lesions, but neither NPHP1 gene deletion nor UMOD (uromodulin) mutation were identified. No association between fibrous dysplasia of bone and nephronophthisis has yet been described. Nephronophthisis-like nephritis associated with fibrous dysplasia of bone might represent a possible new syndrome in the nephronophthisis and medullary cystic kidney disease complex. However, a fortuitous association between these two conditions is also possible.

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“…Finally, the use of bisphosphonates has also been associated with acute kidney failure, related to a direct toxic effect on the tubular epithelium causing acute proximal tubular necrosis [23,24] or tubulo-interstitial inflammation [25,26].…”

Section: Renal Side Effects Of Bisphosphonatesmentioning

confidence: 99%

Nephrotic syndrome induced by pamidronate

2010

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Two patients developed nephrotic syndrome and progressive loss of renal function following treatment with i.v. pamidronate. Renal biopsy revealed collapsing focal segmental glomerulosclerosis (FSGS) in both the patients. In one patient, renal function recovered and the nephrotic syndrome disappeared after discontinuation of pamidronate. The second patient became dialysis dependent despite discontinuation of therapy. Nephrotic syndrome due to collapsing FSGS is a serious complication of treatment with bisphosphonates, especially of i.v. pamidronate. Bisphosphonates may also cause renal insufficiency as a result of tubular toxicity. In order to prevent severe nephrotoxicity clinicians should check urinary protein excretion and renal function regularly in patients who receive long-term treatment with i.v. bisphosphonates. In patients with pre-existing renal impairment (estimated GFR below 30 ml/min), bisphosphonates should be used with caution.

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Pamidronate-induced nephrotoxic tubular necrosis a case report

Cited by 35 publications

References 0 publications

Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

Nephronophthisis-like nephritis associated with fibrous dysplasia of bone

Nephrotic syndrome induced by pamidronate

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Pamidronate-induced nephrotoxic tubular necrosis  a case report

Cited by 35 publications

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Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

Nephronophthisis-like nephritis associated with fibrous dysplasia of bone

Nephrotic syndrome induced by pamidronate

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Pamidronate-induced nephrotoxic tubular necrosis a case report