[Zoledronate-associated end stage renal failure and hypocalcaemia].
In an 81-year-old patient with a history of long-standing stable chronic renal failure a diagnosis of multiple myeloma was made. After an initial chemotherapy, a therapy with intravenous pamidronate, 90 mg monthly, was initiated. After four years of well tolerated therapy, pamidronate was stopped and zoledronate, 4 mg intravenously every four weeks, was started. After approximately one year, an elevated plasma creatinine was noted for the'first time, progressing to end stage renal failure within the next months. At admission, besides end-stage renal failure, severe asymptomatic hypocalcemia was noted. Renal biopsy findings included severe tubulointerstitial damage compatible with drug-induced tubular injury. Prerenal and postrenal failure could be excluded as well as myeloma kidney. The diagnosis of zoledronate-associated end-stage renal failure was made and treatment with hemodialysis was started. Hypocalcemia was treated with calcium and vitamin D3 supplements. After two years of follow up, the patient still required hemodialysis.
Ramazzina
C
C
Departement Innere Medizin, Universitätsspital Basel.
Zysset Aschmann
Y
Y
Kummer
O
O
Rätz Bravo
A E
AE
Bodmer
M
M
D058186:Acute Kidney Injury / Q000139:chemically induced; D016907:Adverse Drug Reaction Reporting Systems; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002118:Calcium / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000139:chemically induced*; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D007684:Kidney Tubules / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications; D000077268:Pamidronate; D006435:Renal Dialysis; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D014807:Vitamin D; D000077211:Zoledronic Acid; D003404:Creatinine; D000077268:Pamidronate; D002118:Calcium