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Nephrotic syndrome induced by pamidronate

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Abstract

Two patients developed nephrotic syndrome and progressive loss of renal function following treatment with i.v. pamidronate. Renal biopsy revealed collapsing focal segmental glomerulosclerosis (FSGS) in both the patients. In one patient, renal function recovered and the nephrotic syndrome disappeared after discontinuation of pamidronate. The second patient became dialysis dependent despite discontinuation of therapy. Nephrotic syndrome due to collapsing FSGS is a serious complication of treatment with bisphosphonates, especially of i.v. pamidronate. Bisphosphonates may also cause renal insufficiency as a result of tubular toxicity. In order to prevent severe nephrotoxicity clinicians should check urinary protein excretion and renal function regularly in patients who receive long-term treatment with i.v. bisphosphonates. In patients with pre-existing renal impairment (estimated GFR below 30 ml/min), bisphosphonates should be used with caution.

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Acknowledgments

The authors would like to thank H. Dijkman and H. Steenbergen, department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, for providing the figures of the kidney biopsies. The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Canisius Wilhelmina Hospital, P.O. Box 9015, 6500, Nijmegen, The Netherlands

    M. A. G. J. ten Dam

  2. Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    L. B. Hilbrands & J. F. M. Wetzels

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  1. M. A. G. J. ten Dam
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  3. J. F. M. Wetzels
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Correspondence to M. A. G. J. ten Dam.

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ten Dam, M.A.G.J., Hilbrands, L.B. & Wetzels, J.F.M. Nephrotic syndrome induced by pamidronate. Med Oncol 28, 1196–1200 (2011). https://doi.org/10.1007/s12032-010-9628-7

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  • DOI: https://doi.org/10.1007/s12032-010-9628-7

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