Ifosfamide-induced Fanconi syndrome.
OBJECTIVE
To report a case of possible ifosfamide-induced Fanconi syndrome in and adult with cancer.


METHODS
A 20-year old man was treated for an osteosarcoma with a chemotherapy regimen that included ifosfamide, methotrexate, and doxorubicin. Three months after completing therapy he developed polyuria, polydypsia, and bilateral ankle pain. Laboratory findings showed decreased serum concentrations of phosphorus, uric acid, calcium potassium, and bicarbonate; elevated blood urea nitrogen and creatinine; and increased urinary excretion of phosphorus, potassium, calcium, citrate, and protein. The patient was diagnosed with Fanconi syndrome and osteomalacia. Treatment with oral supplements of potassium, sodium, citric acid, calcium, and calcitriol corrected the electrolyte abnormalities.


CONCLUSIONS
The adverse effect most frequently associated with ifosfamide is hemorrhagic cystitis. The incidence of hemorrhagic cystitis is decreased with the concomitant administration of the uroprotective agent mesna. The development of Fanconi syndrome after ifosfamide therapy has been described previously, although it occurs more frequently in children than adults. the mechanism by which ifosfamide causes renal tubular damage is not well understood, but it appears to involve metabolites of the drug.


CONCLUSIONS
The development of renal tubular defects and renal failure should be considered in patients receiving ifosfamide. Although this complication appears more frequently in children, adults also can be affected. Renal function should be monitored closely to detect the appearance of this adverse effect. Renal tubular dysfunction can, as this case illustrates, develop months after completing chemotherapy.
Garcia
A A
AA
Department of Internal Medicine, University of Illinois at Urbana-Champaign, USA.
D000328:Adult; D001859:Bone Neoplasms / Q000150:complications / Q000188:drug therapy; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects*; D008297:Male; D010018:Osteomalacia / Q000150:complications; D012516:Osteosarcoma / Q000150:complications / Q000188:drug therapy
D007069:Ifosfamide