Open AccessIfosfamide nephrotoxicity in adult patients
Author(s) -
G. Ensergueix,
Nicolas Pallet,
Dominique Joly,
Charlène Lévi,
Sophie Chauvet,
Claire Trivin,
Jean-François Augusto,
Rémi Boudet,
Haïl Aboudagga,
Guy Touchard,
Dominique Nochy,
Marie Essig,
Éric Thervet,
Hélène Lazareth,
Alexandre Karras
Publication year - 2019
Publication title -
clinical kidney journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.033
H-Index - 40
eISSN - 2048-8513
pISSN - 2048-8505
DOI - 10.1093/ckj/sfz183
Subject(s) - medicine , ifosfamide , nephrotoxicity , acute kidney injury , nephrology , kidney disease , kidney , urology , gastroenterology , acute tubular necrosis , pathology , chemotherapy , cisplatin
Background Ifosfamide, a widely prescribed antineoplasic agent, is frequently associated with kidney dysfunction. Its nephrotoxicity is well documented in children, but data are lacking in adult patients. Methods The aim of this retrospective study was to describe the clinical, biological and histological characteristics of ifosfamide nephrotoxicity. Results We report 34 patients (median age: 41 years) admitted in six French nephrology departments for kidney failure and/or tubular dysfunction. Fifteen patients (44.1%) received cisplatin as part of their chemotherapy. In 6 patients (17.7%), ifosfamide nephrotoxicity was revealed by a proximal tubular dysfunction (PTD), in 5 patients (14.4%) by an acute kidney injury (AKI), in 6 patients (17.7%) by a chronic kidney disease (CKD) and in 17 patients (49.7%) by an association of PTD and AKI. Fourteen renal biopsies (41.2%) were performed and revealed acute tubular necrosis (85.7%), vacuolation (78.6%) and nuclear atypias (71.4%) of renal epithelial cells, interstitial inflammation (71.4%) and fibrosis (57.1%). Electron microscopy showed mitochondrial enlargement and dysmorphic changes suggestive of mitochondrial toxicity. Ten patients (29.4%) progressed to Stage 5 CKD, six (17.6%) required haemodialysis and six patients died during a median follow-up period of 31 months. Risk factors for Stage 5 CKD were age and cisplatin co-administration.