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Concentrating capacity in ifosfamide-induced severe renal dysfunction
R Rossi1, A Gödde, A Kleinebrand
1University Children's Hospital, Münster, Germany.
Insights
Defective renal concentrating capacity is rare in ifosfamide-induced renal dysfunction, primarily affecting patients with overt Fanconi syndrome. Early evaluation of concentrating capacity and sodium handling is crucial to prevent dehydration risks.
Area of Science:
- Nephrology
- Oncology
- Pharmacology
Background:
- Ifosfamide chemotherapy can cause renal dysfunction, including Fanconi syndrome.
- Previous studies suggest subclinical renal impairment may present with low urine osmolarity.
- The frequency of impaired concentrating capacity in ifosfamide-induced Fanconi syndrome requires further investigation.
Purpose of the Study:
- To determine the frequency of defective renal concentrating capacity in patients with ifosfamide-induced Fanconi syndrome or severe proximal tubular dysfunction.
- To assess the relationship between overt Fanconi syndrome and impaired urinary concentrating ability.
Main Methods:
- Evaluated 7 patients with overt Fanconi syndrome and 5 with subclinical tubulopathy.
- Measured urinary osmolarity after overnight fasting and DDAVP (1-D-amino-8-D-arginine vasopressin) administration.
- Assessed proximal tubular solute reabsorption and glomerular filtration rate.
Main Results:
- Five of 7 patients with overt Fanconi syndrome showed decreased urinary osmolarity in at least one test.
- No patients with subclinical tubular damage exhibited decreased osmolarity.
- Increased sodium excretion was observed in 4 patients with overt Fanconi syndrome.
Conclusions:
- Impaired renal concentrating capacity is uncommon in ifosfamide-induced renal dysfunction and is limited to patients with overt Fanconi syndrome.
- Patients with overt Fanconi syndrome require evaluation of concentrating capacity and sodium handling.
- Decreased concentrating capacity and increased sodium excretion increase dehydration risk.
Background:
Diabetes insipidus renalis has only occasionally been reported in ifosfamide-induced renal Fanconi's syndrome, but in two studies on subclinical renal impairment, low morning urine osmolarity was found in high frequencies. This study was performed to assess the frequency of defective concentrating capacity in patients with ifosfamide-induced renal Fanconi's syndrome or severe impairment of proximal tubular function.
Patients And Methods:
Seven patients with overt Fanconi's syndrome and 5 with a generalized but subclinical tubulopathy were examined. Beside proximal tubular solute reabsorption and estimation of glomerular filtration rate, urinary osmolarity was measured after overnight fast and DDAVP (1-D-amino-8-D-arginine vasopressin) testing.
Results:
Five out of 7 patients with overt Fanconi's syndrome, but no patient with only subclinical tubular damage, had decreased osmolarities by at least one test. Increased sodium excretion was additionally found in 4 of these patients.
Conclusion:
Impaired renal concentrating capacity is a rare event in ifosfamide-induced renal dysfunction and confined to patients with overt Fanconi's syndrome. These patients should, however, undergo evaluation of concentrating capacity and renal sodium handling as decreased concentrating capacity and increased sodium excretion would render a patient at risk for dehydration episodes.
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