JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF CASE STUDIES
Zoledronic Acid-Induced Acute Renal Failure in Multiple Myeloma
Authored by Salem Bouomrani
Abstract
Introduction: Despite its potential severity,
the renal toxicity induced by zoledronate acid (ZA) is poorly studied
and little characterized in current medical practice. Acute renal
failure with zoledronate in multiple myeloma (MM) has only been reported
by a few authors as sporadic cases. We are reporting an original
observation of ZA-induced early nephrotoxicity during MM treatment.
Case report: A 74-year-old female, with no
notable pathological history, was explored for recent deterioration of
the general condition with diffuse inflammatory rachialgia and bone
pain. Investigations concluded to the diagnosis of IgG lambda
Durie-Salmon stage IIIA MM. She was treated with six courses of
melphalan-prednisolone-thalidomide (MPT) chemotherapy with a favorable
initial outcome. The subsequent evolution was marked by the occurrence
of two episodes of progression that were treated with two cycles of six
MPT courses. Monthly infusions of ZA (Zometa®) at a dose of 4 mg were
prescribed for very painful bone metastases. When admitted for the third
infusion, the assessment noted acute renal failure with creatinine at
279μmol/l. Stopping Zometa® and adequate hydration allowed gradual
normalization of renal function with creatinine at 194μmol/l after one
week, 115μmol/l after one month, and 83μmol/l after two months.
Conclusion: ZA should be used with caution in
MM, and regular monitoring of renal function is recommended. These
measures are particularly useful if frequent administration of this
drug, associated risk factors, and pre-existing renal lesions.
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