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[Ifosphamide nephrotoxicity].

Gaël Ensergueix1, Alexandre Karras2

  • 1Service de néphrologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.

Nephrologie & Therapeutique
|April 3, 2018
PubMed
Summary
This summary is machine-generated.

Ifosfamide chemotherapy can cause severe kidney damage, including renal failure and Fanconi syndrome, even months after treatment. This nephrotoxicity may be irreversible, particularly in older patients or those receiving cisplatin.

Keywords:
Fanconi syndromeIfosfamideInsuffisance rénaleKidney failureSyndrome de FanconiTubulopathieTubulopathy

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Area of Science:

  • Nephrology
  • Oncology
  • Pharmacology

Background:

  • Ifosfamide is a cytotoxic chemotherapy agent used for malignant sarcomas.
  • Nephrotoxicity from ifosfamide is well-documented in children, presenting as renal failure and proximal tubulopathy.
  • Limited data exists on ifosfamide-induced nephrotoxicity in adult patients.

Purpose of the Study:

  • To describe the clinical characteristics and outcomes of ifosfamide-induced nephrotoxicity in adult patients.
  • To identify risk factors associated with poor renal prognosis in this cohort.

Main Methods:

  • Retrospective multicenter study.
  • Inclusion of 34 adult patients diagnosed with ifosfamide nephrotoxicity.
  • Analysis of clinical data, renal function tests, renal biopsy findings, and long-term outcomes.

Main Results:

  • Over 80% of patients experienced renal failure, with diagnosis up to 48 months post-ifosfamide.
  • Fanconi syndrome was observed in two-thirds of cases, characterized by electrolyte and protein abnormalities.
  • Renal biopsies indicated acute tubular necrosis with mitochondrial damage, suggesting a tenofovir-like mechanism.
  • Ten patients progressed to end-stage renal disease (Stage 5 CKD), with five requiring dialysis.
  • Concomitant cisplatin use and older age were associated with poorer renal outcomes.

Conclusions:

  • Ifosfamide nephrotoxicity in adults is often severe and irreversible, manifesting as proximal tubulopathy and chronic kidney disease.
  • Nephrotoxicity can be delayed, with diagnoses occurring months after chemotherapy cessation.
  • Risk factors like cisplatin co-administration and advanced age necessitate careful monitoring and consideration of renal function.