Toxic acute tubular necrosis following treatment with zoledronate (Zometa)

Markowitz, Glen S.; Fine, Paul L.; Stack, Jay I.; Kunis, Cheryl L.; Radhakrishnan, Jai; W, Palecki; Park, Jin; Nasr, Samih H.; Hoh, Shirley; Siegel, David S.; D’Agati, Vivette D.

doi:10.1046/j.1523-1755.2003.00071.x

Cited by 344 publications

(224 citation statements)

References 18 publications

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“…Bisphosphonates are very effective for the management of malignancy-related hypercalcemia; however, myeloma patients presenting with acute renal failure are at risk for complications such as renal toxicity and subsequent hypocalcemia when bisphosphonates are administered. 41 Thus, close monitoring is needed in these patients, whereas mild asymptomatic hypercalcemia should preferably be managed with conservative measures such as hydration. For moderate or severe hypercalcemia, the prompt initiation of antimyeloma therapy, which includes steroids, is indicated.…”

Section: Supportive Carementioning

confidence: 99%

Pathogenesis and treatment of renal failure in multiple myeloma

et al. 2008

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Renal failure is a frequent complication in patients with multiple myeloma (MM) that causes significant morbidity. In the majority of cases, renal impairment is caused by the accumulation and precipitation of light chains, which form casts in the distal tubules, resulting in renal obstruction. In addition, myeloma light chains are also directly toxic on proximal renal tubules, further adding to renal dysfunction. Adequate hydration, correction of hypercalcemia and hyperuricemia and antimyeloma therapy should be initiated promptly. Recovery of renal function has been reported in a significant proportion of patients treated with conventional chemotherapy, especially when high-dose dexamethasone is also used. Severe renal impairment and large amount of proteinuria are associated with a lower probability of renal recovery. Novel agents, such as thalidomide, bortezomib and lenalidomide, have significant activity in pretreated and untreated MM patients. Although there is limited experience with thalidomide and lenalidomide in patients with renal failure, data suggest that bortezomib may be beneficial in this population. Clinical studies that have included newly diagnosed and refractory patients indicate that bortezomib-based regimens may result in rapid reversal of renal failure in up to 50% of patients and that full doses of bortezomib can be administered without additional toxicity.

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Section: Supportive Carementioning

confidence: 99%

Pathogenesis and treatment of renal failure in multiple myeloma

et al. 2008

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“…However, all BPs have the potential for adversely affecting renal function; indeed, sporadic episodes of acute and subacute renal failure have been described for several i.v. BPs [6][7][8][9][10][11][12][13]. However, this toxicity is extremely rare when the agents are administered at their recommended doses and infusion rates.…”

Section: Introductionmentioning

confidence: 99%

Renal Safety and Efficacy of i.v. Bisphosphonates in Patients with Skeletal Metastases Treated for up to 10 Years

Guarneri

Donati²,

Nicolini

et al. 2005

The Oncologist

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Introduction. Bisphosphonates (BPs) delay the onset or reduce the incidence of skeletal complications in patients with bone metastases. However, there are few data on the renal safety and activity of i.v. BPs beyond 2 years of administration.Materials and Methods. We retrospectively analyzed serum creatinine (SCr) levels and skeletal-related events (SREs) in cancer patients receiving i.v. BPs for ≥24 months. All patients received 90 mg pamidronate every 3-4 weeks. Pre-and post-treatment SCr levels and the peak levels attained were recorded. A notable SCr increase was defined as: an increase >0.5 mg/dl for patients with baseline SCr <1.4 mg/dl; an increase >1 mg/dl for patients with baseline SCr >1.4 mg/dl; or doubling over baseline. The following parameters were also analyzed: the proportion of patients with at least one SRE, the distribution of each type of SRE, the time to first SRE, and the skeletal morbidity rate (SMR).Results. Fifty-seven patients with bone metastases resulting from breast cancer (BC) (n = 48), multiple myeloma (n = 7), renal cell carcinoma (n = 1), and prostate cancer (n = 1) were evaluated. The median age at the start of treatment was 57 years (range, 27-81); 25% of the patients were >70 years old. Forty-three patients

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“…In these cases, patterns of nephrotoxicity consist of toxic acute tubular necrosis and collapsing focal segmental glomerulosclerosis (Chang et al 2003;Perazella & Markowitz 2008). In another study, acute toxic tubular necrosis following treatment with a BP agent named zoledronate was reported (Markowitz et al 2003). In addition, collapsing focal segmental glomerulosclerosis following treatment with a high dose of another BP agent named pamidronate in multiple myeloma and metastatic breast carcinoma patients was noticed (Markowitz et al 2001).…”

Section: Discussionmentioning

confidence: 98%