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Acute Tubular Necrosis Attributed to High-Dose Everolimus with High-Potency Bisphosphonates for Advanced Breast
Itamar Loewenstein1,2, Nimrod Orr Urtreger1,2, Doron Schwartz2,3
1Internal Medicine Department J, Tel Aviv Medical Center, Tel Aviv, Israel.
Introduction:
Everolimus (EVR)-induced kidney injury is rarely reported. Conversely, acute tubular necrosis (ATN) is a recognized complication of high-dose bisphosphonate therapy.
Case Presentation:
SM, a 69-year-old female patient with advanced breast cancer, developed severe kidney injury necessitating renal replacement therapy (RRT) shortly after initiating EVR treatment, while concurrently receiving chronic high-potency bisphosphonate therapy. Kidney biopsy confirmed ATN. Upon discontinuation of both EVR and bisphosphonates, her renal function gradually improved over several months, leading to the cessation of RRT. At a 2-year follow-up, her kidney function has returned to baseline.
Conclusion:
In this case report, we outline the patient's clinical course and provide a pathophysiological rationale for the synergistic effect of EVR and bisphosphonates in promoting ATN. With the increasing use of EVR in various oncologic indications, we emphasize the reversible nature of this kidney injury and stress the importance of timely recognition and intervention.
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