Collapsing focal segmental glomerulosclerosis following long-term treatment with oral ibandronate: case report and review of literature

BMC Cancer. 2015 Jul 22;15:535. doi: 10.1186/s12885-015-1536-y.

Abstract

Background: Renal toxicity has been reported with bisphosphonates such as pamidronate and zolidronate but not with ibandronate, in the treatment of breast cancer patients with bone metastasis. One of the patterns of bisphosphonate-induced nephrotoxicity is focal segmental glomerulosclerosis (FSGS) or its morphological variant, collapsing focal segmental glomerulosclerosis (CFSGS).

Case presentation: We describe a breast cancer patient who developed heavy proteinuria (protein/creatinine ratio 9.1) and nephrotic syndrome following treatment with oral ibandronate for 29 months. CFSGS was proven by biopsy. There was no improvement 1 month after ibandronate was discontinued. Prednisone and tacrolimus were started and she experienced a decreased in proteinuria.

Conclusion: In patient who develops ibandronate-associated CFSGS, proteinuria appears to be at least partially reversible with the treatment of prednisone and/or tacrolimus if the syndrome is recognized early and ibandronate is stopped.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Oral
  • Adult
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / adverse effects*
  • Bone Neoplasms / drug therapy*
  • Bone Neoplasms / secondary
  • Breast Neoplasms / drug therapy*
  • Diphosphonates / administration & dosage
  • Diphosphonates / adverse effects*
  • Female
  • Glomerulosclerosis, Focal Segmental / drug therapy
  • Glomerulosclerosis, Focal Segmental / etiology
  • Glomerulosclerosis, Focal Segmental / pathology*
  • Humans
  • Ibandronic Acid
  • Prednisone / administration & dosage
  • Proteinuria / drug therapy
  • Proteinuria / etiology
  • Tacrolimus / administration & dosage
  • Treatment Outcome

Substances

  • Bone Density Conservation Agents
  • Diphosphonates
  • Ibandronic Acid
  • Prednisone
  • Tacrolimus