Cancer Research and Treatment  2010;42(4):244-246

Reversible Proximal Renal Tubular Dysfunction after One-Time Ifosfamide Exposure.

Young Il KIM 1 ; Ju Young YOON ; Jun Eul HWANG ; Hyun Jeong SHIM ; Woo Kyun BAE ; Sang Hee CHO ; Ik Joo CHUNG

Affiliations

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Keywords

Ifosfamide; Proximal kidney tubules; Fanconi syndrome

Country

Republic of Korea

Language

English

Abstract

The alkylating agent ifosfamide is an anti-neoplastic used to treat various pediatric and adult malignancies. Its potential urologic toxicities include glomerulopathy, tubulopathy and hemorrhagic cystitis. This report describes a case of proximal renal tubular dysfunction and hemorrhagic cystitis in a 67-year-old male given ifosfamide for epitheloid sarcoma. He was also receiving an oral hypoglycemic agent for type 2 diabetes mellitus and had a baseline glomerular filtration rate of 51.5 mL/min/1.73 m2. Despite mesna prophylaxis, the patient experienced dysuria and gross hematuria after a single course of ifosfamide plus adriamycin. The abrupt renal impairment and serum/urine electrolyte imbalances that ensued were consistent with Fanconi's syndrome. However, normal renal function and electrolyte status were restored within 14 days, simply through supportive measures. A score of 8 by Naranjo adverse drug reaction probability scale indicated these complications were most likely treatment-related, although they developed without known predisposing factors. The currently undefined role of diabetic nephropathy in adult ifosfamide nephrotoxicity merits future investigation.