Zoledronic Acid-Induced Acute Renal Failure in Multiple Myeloma

Abstract

Introduction: Despite its potential severity, the renal toxicity induced by zoledronate acid (ZA) is poorly studied and little characterized in current medical practice. Acute renal failure with zoledronate in multiple myeloma (MM) has only been reported by a few authors as sporadic cases. We are reporting an original observation of ZA-induced early nephrotoxicity during MM treatment.Case report: A 74-year-old female, with no notable pathological history, was explored for recent deterioration of the general condition with diffuse inflammatory rachialgia and bone pain. Investigations concluded to the diagnosis of IgG lambda Durie-Salmon stage IIIA MM. She was treated with six courses of melphalan-prednisolone-thalidomide (MPT) chemotherapy with a favorable initial outcome. The subsequent evolution was marked by the occurrence of two episodes of progression that were treated with two cycles of six MPT courses. Monthly infusions of ZA (Zometa®) at a dose of 4 mg were prescribed for very painful bone metastases. When admitted for the third infusion, the assessment noted acute renal failure with creatinine at 279μmol/l. Stopping Zometa® and adequate hydration allowed gradual normalization of renal function with creatinine at 194μmol/l after one week, 115μmol/l after one month, and 83μmol/l after two months. Conclusion:ZA should be used with caution in MM, and regular monitoring of renal function is recommended. These measures are particularly useful if frequent administration of this drug, associated risk factors, and pre-existing renal lesions.