Severe renal failure following high-dose ifosfamide and mesna

Willemse, Phb; Dejong, Pe; Elema, Jd; Mulder, Nh

doi:10.1007/bf00292414

Cited by 42 publications

(14 citation statements)

References 8 publications

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“…There are several reports of the finding of renal biopsy for ifosfamide-induced late nephropathy [3,[8][9][10][11][12]. Most of reports show the chronic tubulointerstitial damage, although segmental glomerular sclerosis was also reported [8], which were also found in the present case.…”

Section: Discussionsupporting

confidence: 72%

Improvement in karyomegalic interstitial nephritis three years after ifosfamide and cisplatin therapy by corticosteroid

et al. 2014

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Long-term nephrotoxicity of ifosfamide is occasionally progressive, and, in such case, there has been no specific treatment to prevent progression. It has been reported that the presence of karyomegalic interstitial nephritis, which is rare type of interstitial nephritis, may be related to ifosfamide-induced nephropathy with poor prognosis and resistant to the immunosuppressive therapy. A 15-year-old boy presented with progressive nephrotoxicity 3 years after systemic chemotherapy with ifosfamide and cisplatin for the treatment of osteosarcoma. Renal biopsy revealed the severe tubulointerstitial nephritis with tubular atrophy and focal global and segmental glomerular sclerosis. It also showed tubular epithelial cells with variably sized nuclei, some of which were massively enlarged, abnormal hyperchromatic, irregular shaped, and bizarreappearing. These morphological changes were suggestive of the histology of karyomegalic interstitial nephritis. Corticosteroid retarded the progression of nephrotoxicity. The present case is the first report, suggesting that corticosteroid was effective against the late-onset renal toxicity by ifosfamide therapy. Our case also suggests that karyomegalic interstitial nephritis may be the result of long-term nephrotoxicity of ifosfamide. Since concurrent treatment with cisplatin is one of the risk factors for ifosfamide nephrotoxicity, there is a possibility that cisplatin may have a synergetic effect with ifosfamide for producing karyomegalic interstitial nephritis.

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Section: Discussionsupporting

confidence: 72%

Improvement in karyomegalic interstitial nephritis three years after ifosfamide and cisplatin therapy by corticosteroid

et al. 2014

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“…Furthermore, amongst the other drugs that he had received 10 years ago, cyclophosphamide and vincristine have acute effects on water excretion but do not cause chronic renal failure [8], and acute adriamycin nephrotoxicity is rare and is associated with severe cardiomyopathy [8], which was absent in this patient. Ifosfamide-induced tubular dysfunction may be more common in the very young [3,9], however it may not be by chance that chronic renal failure has been reported mainly in older patients [10][11][12] since age increases the susceptibility to various nephrotoxic agents [13,14]. Renal biopsy findings after ifosfamide therapy have been reported in only a few cases (table 1) and, to our knowledge, there are no such reports at such a late stage, 10 years following therapy.…”

Section: Discussionmentioning

confidence: 62%

End-Stage Renal Interstitial Fibrosis in an Adult Ten Years after Ifosfamide Therapy

Friedlaender

Haviv

Rosenmann³

et al. 1998

Am J Nephrol

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A 33-year-old male presented with end-stage renal failure. Renal biopsy showed severe interstitial fibrosis without glomerulopathy or vasculopathy. More than 10 years previously the patient had been successfully treated for recurrent rhabdomyosarcoma. The treatment included ifosfamide, a drug known to cause acute tubular dysfunction. Though a possible synergistic effect of previous radiation which was well within accepted tolerance limits cannot be excluded, it would appear that ifosfamide was almost certainly the major cause of the late onset chronic renal disease.

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“…Severe irreversible renal failure has been attributed to ifosfamide treatment in three case reports of adult patients who had renal biopsies [13][14][15]. Although diffuse tubular epithelial damage with degenerative and regenerative epithelial changes were reported, the features were not apparently the same as those for KIN and the more consistent feature was diffuse interstitial fibrosis.…”

Section: Discussionmentioning

confidence: 90%

Karyomegalic-like nephropathy, Ewing’s sarcoma and ifosfamide therapy

et al. 2011

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Karyomegalic interstitial nephropathy has been reported as a rare interstitial nephritis in adult patients. Histology shows atypical epithelial cells and large abnormal hyperchromatic nuclei with irregular outlines. We report 3 adolescent patients who all recovered from their initial treatment for Ewing's sarcoma but developed a tubulopathy attributed to ifosfamide therapy. Renal impairment resulted in biopsy, which showed features of karyomegalic nephropathy in all 3. One patient has progressed to haemodialysis. Recognition of the pathology may be important in similar patients. It is surmised that the unusual histological findings in these patients stem from a common pathogenesis which may be related to chemotherapeutic agent related nuclear damage. At present there is no specific treatment to prevent progressive renal impairment.

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Severe renal failure following high-dose ifosfamide and mesna

Cited by 42 publications

References 8 publications

Improvement in karyomegalic interstitial nephritis three years after ifosfamide and cisplatin therapy by corticosteroid

Improvement in karyomegalic interstitial nephritis three years after ifosfamide and cisplatin therapy by corticosteroid

End-Stage Renal Interstitial Fibrosis in an Adult Ten Years after Ifosfamide Therapy

Karyomegalic-like nephropathy, Ewing’s sarcoma and ifosfamide therapy

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