A case of ifosfamide-induced acute kidney injury, Fanconi syndrome, and nephrogenic diabetes insipidus

Ifosfamide, a cytotoxic antineoplastic drug, can induce rare complications of Fanconi syndrome and nephrogenic diabetes insipidus (DI). Ifosfamide-induced Fanconi syndrome tends to occur in patients with certain risk factors including young age, high cumulative ifosfamide dose, and coadministration...

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Bibliographic Details
Published in:CEN case reports 2024-06, Vol.13 (3), p.194-198
Main Authors: Hoang, Summer, Pujar, Thejeswi, Bellorin-Font, Ezequiel, Edwards, John C., Miyata, Kana N.
Format: Article
Language:English
Subjects:
Acute Kidney Injury - chemically induced
Antineoplastic Agents, Alkylating - adverse effects
Case Report
Deamino Arginine Vasopressin - administration & dosage
Deamino Arginine Vasopressin - adverse effects
Deamino Arginine Vasopressin - therapeutic use
Diabetes Insipidus, Nephrogenic - chemically induced
Fanconi Syndrome - chemically induced
Humans
Hypokalemia - chemically induced
Ifosfamide - adverse effects
Ifosfamide - therapeutic use
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Urology
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Summary:Ifosfamide, a cytotoxic antineoplastic drug, can induce rare complications of Fanconi syndrome and nephrogenic diabetes insipidus (DI). Ifosfamide-induced Fanconi syndrome tends to occur in patients with certain risk factors including young age, high cumulative ifosfamide dose, and coadministration of cisplatin. Nephrogenic DI causes polyuria from impaired urinary concentrating ability due to resistance to arginine vasopressin (AVP) at the collecting duct. These complications are serious and potentially fatal. Here, we describe a case of a middle-aged man without risk factors who was admitted for the management of acute kidney injury and electrolyte derangements after his fourth cycle of chemotherapy including ifosfamide for synovial sarcoma. He was found to have hypokalemia, hypophosphatemia, renal glycosuria, and aminoaciduria, likely from Fanconi syndrome, which were managed by electrolyte replacement therapy. In addition, polyuria and hypernatremia were considered due to nephrogenic DI, which partially responded to desmopressin treatment. This case highlights the importance of the routine electrolytes monitoring after ifosfamide treatment.
ISSN:2192-4449
2192-4449
DOI:10.1007/s13730-023-00829-z