title: Chronic Ifosfamide toxicity: kidney pathology and pathophysiology.
abstract: Ifosfamide is a nitrogen mustard alkylating agent used as both a first-line and a salvage chemotherapeutic agent in the treatment of testicular germ cell tumors, various sarcomas, carcinomas, and some lymphomas. A well-known complication of ifosfamide therapy is transient acute kidney injury. However, in a minority of patients, the reduction in kidney function is progressive and permanent, sometimes occurring long after exposure to ifosfamide. Scattered reports have described the pathologic findings in kidneys permanently affected by ifosfamide toxicity. We present the findings of an illustrative case and review the pathology and molecular mechanisms of long-term ifosfamide toxicity with implications for personalized medicine.
authors: Department of Pathology, University of Washington, Seattle, WA. Electronic address: shreeram@uw.edu.
authors: Shreeram
authors: S
authors: Akilesh
authors: Division of Nephrology, Department of Internal Medicine, University of Washington, Seattle, WA.
authors: Noemie
authors: N
authors: Juaire
authors: Division of Nephrology, Department of Internal Medicine, University of Washington, Seattle, WA.
authors: Jeremy S
authors: JS
authors: Duffield
authors: Department of Pathology, University of Washington, Seattle, WA.
authors: Kelly D
authors: KD
authors: Smith
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects*; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D006435:Renal Dialysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D007069:Ifosfamide
keywords: Ifosfamide; chemotherapy-related injury; chronic kidney injury; drug toxicity; tubular toxicity