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Bendamustine-induced nephrogenic diabetes insipidus
Clinical Nephrology
|October 11, 2016
Summary
This case report details nephrogenic diabetes insipidus (DI) in a patient treated with rituximab and bendamustine for chronic lymphocytic leukemia. Bendamustine is implicated as the likely cause of this rare adverse effect.
Area of Science:
- Nephrology
- Oncology
- Pharmacology
Background:
- Chronic lymphocytic leukemia (CLL) treatment often involves chemotherapy agents.
- Rituximab and bendamustine are commonly used in CLL therapy.
- Chemotherapy can have various systemic side effects, including renal toxicity.
Observation:
- A 59-year-old male developed polyuria and polydipsia post-rituximab and bendamustine treatment.
- The patient experienced acute hypernatremia with inappropriately dilute urine, unresponsive to desmopressin.
- Symptoms resolved with oral fluid reintroduction and infection treatment, but persisted long-term.
Findings:
- Diagnosis of nephrogenic diabetes insipidus (DI) was confirmed by lack of response to desmopressin.
- Hydrochlorothiazide treatment effectively increased urine osmolality and reduced urine output.
- This represents the first reported case of nephrogenic DI following rituximab and bendamustine therapy.
Implications:
- Bendamustine is proposed as the causative agent for nephrogenic DI, potentially due to glomerular and proximal tubule toxicity.
- Clinicians should consider monitoring for DI in patients receiving bendamustine-based chemotherapy.
- Further research is warranted to elucidate the mechanism of bendamustine-induced nephrotoxicity.
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