Pemetrexed-Induced Nephrogenic Diabetes Insipidus

Am J Kidney Dis. 2016 Oct;68(4):628-632. doi: 10.1053/j.ajkd.2016.04.016. Epub 2016 May 28.


Pemetrexed is an approved antimetabolite agent, now widely used for treating locally advanced or metastatic nonsquamous non-small cell lung cancer. Although no electrolyte abnormalities are described in the prescribing information for this drug, several case reports have noted nephrogenic diabetes insipidus with associated acute kidney injury. We present a case of nephrogenic diabetes insipidus without severely reduced kidney function and propose a mechanism for the isolated finding. Severe hypernatremia can lead to encephalopathy and osmotic demyelination, and our report highlights the importance of careful monitoring of electrolytes and kidney function in patients with lung cancer receiving pemetrexed.

Keywords: Nephrogenic diabetes insipidus; adverse drug reaction; drug toxicity; pemetrexed; proton coupled folate transporters.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Agents / adverse effects*
  • Diabetes Insipidus, Nephrogenic / chemically induced*
  • Humans
  • Male
  • Pemetrexed / adverse effects*


  • Antineoplastic Agents
  • Pemetrexed