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Nephrotoxicity after ifosfamide.

R Skinner1, A D Pearson, L Price

  • 1Department of Child Health, Medical School, Newcastle upon Tyne.

Archives of Disease in Childhood
|July 1, 1990
PubMed
Summary
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Ifosfamide treatment in children can cause significant kidney damage, affecting both glomerular filtration and renal tubules. This study highlights the common occurrence of nephrotoxicity, emphasizing the need for careful monitoring during cancer therapy.

Area of Science:

  • Pediatric Oncology
  • Nephrology
  • Pharmacology

Background:

  • Ifosfamide is a widely used chemotherapy agent for solid tumors in children.
  • Renal toxicity is a known side effect of ifosfamide, but its incidence and spectrum in pediatric patients require further elucidation.

Purpose of the Study:

  • To investigate the incidence and extent of renal damage in children and adolescents treated with ifosfamide.
  • To assess both glomerular and renal tubular function following ifosfamide administration.

Main Methods:

  • Evaluated 11 children and adolescents with extrarenal solid tumors treated with ifosfamide.
  • Assessed glomerular filtration rate using 51Cr-EDTA plasma clearance.
  • Monitored renal tubular function through urine analysis for biomarkers like beta-2 microglobulin, amino acids, phosphate, and glucose, and urine osmolality.

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Main Results:

  • Reduced glomerular filtration rate observed in 6 out of 11 patients.
  • All patients showed evidence of proximal tubular damage (e.g., increased beta-2 microglobulin, aminoaciduria, glycosuria, phosphaturia).
  • Six patients exhibited distal tubular dysfunction; two developed hypophosphatemic rickets, and one had nephrogenic diabetes insipidus.

Conclusions:

  • Ifosfamide treatment is associated with a high incidence of both glomerular and tubular nephrotoxicity in children.
  • Renal complications can be severe, including rickets and diabetes insipidus, necessitating vigilant monitoring of renal function in pediatric patients undergoing ifosfamide therapy.