Nephrotic proteinuria associated with high‐dose pamidronate in multiple myeloma

Abstract

Summary. Five patients receiving increased dose or frequency of pamidronate beyond the recommended dose (90 mg/monthly) exhibited nephrotic proteinuria (range 3AE96-24 g/24 h). On dose reduction or discontinuation, three of these patients showed decreased proteinuria to normal levels (< 1 g/24 h), and proteinuria decreased to 4AE5 g/24 h from a peak of 24 g/24 h in one patient. One patient on haemodialysis (hence not evaluable) had proteinuria of 2 g/24 h and elevated creatinine levels. One other patient continued to show elevated creatinine levels (272AE8 lmol/l). Renal biopsies obtained in two patients revealed focal segmental glomerulosclerosis.

The Role of Bisphosphonates in Multiple Myeloma: Mechanisms, Side Effects, and the Future

“…Furthermore BPs with a long renal tissue half-life, such as ZA [101], can potentially accumulate in renal tissue, contributing to renal damage. Kidney biopsies of patients treated with Pam showed collapsing focal segmented glomerulosclerosis [102][103][104], whereas ZA more often induces acute tubular necrosis with tubular cell degeneration, loss of brush border, and apoptosis [102].…”

Onco-Nephrology

“…However, bisphosphonate-associated nephrotoxicity affecting both glomerular and tubular structures has been described in both case series and randomized clinical trials (35). In terms of glomerular toxicity, bisphosphonates (most commonly, pamidronate and, only rarely, zoledronate) have been associated with collapsing focal segmental glomerulosclerosis (FSGS), noncollapsing FSGS, and minimal-change disease in several case series (52)(53)(54)(55)(56). The most common lesion is collapsing FSGS, which is seen with high-dose IV pamidronate often in patients with underlying multiple myeloma and usually after repeated doses (35).…”

Ibandronate: Its Role in Metastatic Breast Cancer

“…bisphosphonates pamidronate and zoledronic acid have been associated with instances of acute and chronic nephrotoxicity [31][32][33][34][35][36]. Renal damage is associated with high doses and short infusion times, particularly in the case of zoledronic acid, where an 8 mg dose evaluated in phase III trials was discontinued because of the degree of renal toxicity [37][38][39].…”