title: Collapsing focal segmental glomerulosclerosis following long-term treatment with oral ibandronate: case report and review of literature.
abstract: BACKGROUND
  Renal toxicity has been reported with bisphosphonates such as pamidronate and zolidronate but not with ibandronate, in the treatment of breast cancer patients with bone metastasis. One of the patterns of bisphosphonate-induced nephrotoxicity is focal segmental glomerulosclerosis (FSGS) or its morphological variant, collapsing focal segmental glomerulosclerosis (CFSGS).
  
  
  METHODS
  We describe a breast cancer patient who developed heavy proteinuria (protein/creatinine ratio 9.1) and nephrotic syndrome following treatment with oral ibandronate for 29 months. CFSGS was proven by biopsy. There was no improvement 1 month after ibandronate was discontinued. Prednisone and tacrolimus were started and she experienced a decreased in proteinuria.
  
  
  CONCLUSIONS
  In patient who develops ibandronate-associated CFSGS, proteinuria appears to be at least partially reversible with the treatment of prednisone and/or tacrolimus if the syndrome is recognized early and ibandronate is stopped.
authors.affiliation: Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China. jianing1976@yahoo.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Jia
authors.affiliation: Division of Nephrology, Harborview Medical Center, University of Washington, Seattle, WA, 98195, USA. fcormack@nephrology.washington.edu.
authors.forename: Fionnuala C
authors.initials: FC
authors.lastname: Cormack
authors.affiliation: Division of Oncology, Department of Medicine, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, 98109, USA. bxie@highlinemedical.org.
authors.forename: Bin
authors.initials: B
authors.lastname: Xie
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, 98195, USA. zshiue@u.washington.edu.
authors.forename: Zita
authors.initials: Z
authors.lastname: Shiue
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA, 98195, USA. najafian@uw.edu.
authors.forename: Behzad
authors.initials: B
authors.lastname: Najafian
authors.affiliation: Division of Oncology, Department of Medicine, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, 98109, USA. pink@u.washington.edu.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gralow
mesh_terms: D000284:Administration, Oral; D000328:Adult; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D006801:Humans; D000077557:Ibandronic Acid; D011241:Prednisone / Q000008:administration & dosage; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077557:Ibandronic Acid; D011241:Prednisone; D016559:Tacrolimus