Pemetrexed-Induced Nephrogenic Diabetes Insipidus

Area of Science:

• Oncology
• Nephrology
• Pharmacology

Background:

• Pemetrexed is a key antimetabolite chemotherapy for non-small cell lung cancer.
• Prescribing information does not list electrolyte abnormalities as a side effect.
• Case reports link pemetrexed to nephrogenic diabetes insipidus and acute kidney injury.

Observation:

• This report details a case of nephrogenic diabetes insipidus in a lung cancer patient treated with pemetrexed.
• The patient presented with electrolyte imbalance but without significantly impaired kidney function.
• A potential mechanism for this isolated finding is proposed.

Findings:

• Pemetrexed-induced nephrogenic diabetes insipidus can occur without severe renal dysfunction.
• Hypernatremia, a consequence of diabetes insipidus, poses risks like encephalopathy and osmotic demyelination.
• This case highlights a specific adverse effect of pemetrexed therapy.

Implications:

• Clinicians should be vigilant for nephrogenic diabetes insipidus in patients receiving pemetrexed.
• Regular monitoring of electrolytes, particularly sodium, and kidney function is essential.
• Understanding this pemetrexed-related nephrotoxicity can improve patient management and outcomes in lung cancer treatment.