Pamidronate nephrotoxicity

Bisphoshonates are used for treatment of hypercalcemia, fracture prevention and in patients with metastatic cancer. This class of drugs reduce morbidity from hypercalcemia is increasingly recognized to cause nephrotoxicity [14]. Both pamidronate and zoledronate have been associated with nephrotoxicity that features nephrotic syndrome with a collapsing glomerular sclerosis [47]. The mechanism is unkown and the return of renal function is slow. 

Lockridge L, Papac RJ, Perazella MA. Pamidronate-assoclated nephrotoxicity In a patient with Langerhans s histiocytosis. Am J Kidney Dis 2002 40 E2. 

Janssen van Doom K, Neyns B, Van der Niepen P, Verbeelen D. Pamidronate-related nephrotoxicity (tubulointerstitial nephritis) in a patient with osteolytic bone metastases. Nephron 2001 89 467-468. 

Banerjee D, Asif A, Striker L, Preston RA, Bourgoignie JJ, Roth D. Short-term, high-dose pamidronate-induced acute tubular necrosis the postulated mechanisms of bisphosphonate nephrotoxicity. Am J Kidney Dis 2003 41 El 8. 

Smetana S, Michlin A, Rosenman E, Biro A, Boaz M, Katzir Z. Pamidronate-induced nephrotoxic tubular necrosis—a case report. Clin Nephrol 2004 61 63-67. 

Pamidronate has several drug interactions. Aminoglycosides may result in enhanced hypocalcemia. NSAIDs may enhance GI and nephrotoxicity. Phosphate supplements may enhance hypocalcemia. Thalidomide may result in increased nephrotoxicity. 

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