[Nephrotoxicity of ifosfamide with special reference to Fanconi Syndrome]

The article is a case presentation of Fanconi syndrome in a patient treated with high doses of ifosfamide. ifosfamide nephrotoxicity relates to glomerular and tubular disfunction. Tubular disfunction type 2 (Fanconi Syndrome) is observed most often. In this syndrome hypophosphatemia, hyperphosphaturia, glucosuria, polyuria, aminoaciduria, hypokalemia and tubular acidosis are present. The treatment consists of electrolyte supplementation and acidosis reduction. Nephrotoxicity risk factors are: total ifosfamide doses and age under 3 years. Early diagnosis is possible by estimating b2 microglobulin and retinal binding protein. Normally used parameters of renal function are insufficient.

case report - N. W - 13-year-old patient with a skin's tumour was treated in our clinic. Euro Ewing-99 protocol with 100.8 g/m2 of ifosfamide was applied for 18 months. During treatment serum electrolytes, urea, creatinine and creatinine clearance were normal. 6 months after treatment a metastasis in the lung was detected.

Fanconi Syndrome symptoms were noticed before introduction of chemotherapy. After treatment with small doses of ifosfamide (4.5 g/m2) the disorders became severe. For this reason, nephrotoxic cytostatics were excluded from further treatment, decreasing its efficiency.

1. Renal complications of ifosfamide may appear after treatment completion. Monitoring of renal function parameters is necessary during and after treatment. 2. When protocols with cyclophosphamide (less nephrotoxic than ifosfamide) prove to be of similar efficiency, this treatment could be an alternative for patients' with renal disfunction. 3. Patients with completed ifosfamide treatment shall be qualified for repeated chemotherapy carefully due to high-risk of renal disfunction.