Subject(s)
Lesch-Nyhan Syndrome/diagnosis , Spinal Cord Compression/diagnosis , Arthritis, Gouty/complications , Arthritis, Gouty/genetics , Diagnosis, Differential , Epidural Abscess/diagnosis , Humans , Kidney/pathology , Lesch-Nyhan Syndrome/complications , Lesch-Nyhan Syndrome/genetics , Male , Spinal Cord Compression/etiology , Young AdultSubject(s)
Atrioventricular Block/diagnostic imaging , Echocardiography, Three-Dimensional , Granulomatosis with Polyangiitis/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Image Enhancement , Atrioventricular Block/complications , Diagnosis, Differential , Echocardiography, Three-Dimensional/standards , Female , Granulomatosis with Polyangiitis/complications , Heart Neoplasms/complications , Humans , Image Enhancement/standards , Middle AgedABSTRACT
BACKGROUND: Renal toxicity has been reported with bisphosphonates such as pamidronate and zolidronate but not with ibandronate, in the treatment of breast cancer patients with bone metastasis. One of the patterns of bisphosphonate-induced nephrotoxicity is focal segmental glomerulosclerosis (FSGS) or its morphological variant, collapsing focal segmental glomerulosclerosis (CFSGS). CASE PRESENTATION: We describe a breast cancer patient who developed heavy proteinuria (protein/creatinine ratio 9.1) and nephrotic syndrome following treatment with oral ibandronate for 29 months. CFSGS was proven by biopsy. There was no improvement 1 month after ibandronate was discontinued. Prednisone and tacrolimus were started and she experienced a decreased in proteinuria. CONCLUSION: In patient who develops ibandronate-associated CFSGS, proteinuria appears to be at least partially reversible with the treatment of prednisone and/or tacrolimus if the syndrome is recognized early and ibandronate is stopped.
Subject(s)
Bone Density Conservation Agents/adverse effects , Bone Neoplasms/drug therapy , Breast Neoplasms/drug therapy , Diphosphonates/adverse effects , Glomerulosclerosis, Focal Segmental/pathology , Administration, Oral , Adult , Bone Density Conservation Agents/administration & dosage , Bone Neoplasms/secondary , Diphosphonates/administration & dosage , Female , Glomerulosclerosis, Focal Segmental/drug therapy , Glomerulosclerosis, Focal Segmental/etiology , Humans , Ibandronic Acid , Prednisone/administration & dosage , Proteinuria/drug therapy , Proteinuria/etiology , Tacrolimus/administration & dosage , Treatment OutcomeABSTRACT
Levamisole-adulterated cocaine has increased in prevalence over the last decade and is known to be associated with antineutrophil cytoplasmic antibodies (ANCA). Dermatologic manifestations of levamisole exposure, including cutaneous vasculitis, are widely appreciated; less is known about its effects on the kidney. We report two cases of patients with a history of cocaine abuse and levamisole-induced cutaneous vasculitis, who developed acute kidney injury in the setting of elevated ANCA titers. Renal biopsies of both revealed pauci-immune complex glomerulonephritis with diffuse crescentic disease. These cases demonstrate a rare but serious complication of long-term cocaine use.
