长期口服伊班膦酸钠治疗后发生的塌陷型局灶节段性肾小球硬化：病例报告及文献复习
Collapsing focal segmental glomerulosclerosis following long-term treatment with oral ibandronate: case report and review of literature.
作者信息
Jia Ning, Cormack Fionnuala C, Xie Bin, Shiue Zita, Najafian Behzad, Gralow Julie R
机构信息
Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
Division of Nephrology, Harborview Medical Center, University of Washington, Seattle, WA, 98195, USA.
出版信息
BMC Cancer. 2015 Jul 22;15:535. doi: 10.1186/s12885-015-1536-y.
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.
背景
在治疗骨转移乳腺癌患者时，已报道帕米膦酸和唑来膦酸等双膦酸盐会导致肾毒性，但伊班膦酸不会。双膦酸盐诱导的肾毒性模式之一是局灶节段性肾小球硬化（FSGS）或其形态学变异型，即塌陷性局灶节段性肾小球硬化（CFSGS）。
病例报告
我们描述了一名乳腺癌患者，在口服伊班膦酸治疗29个月后出现大量蛋白尿（蛋白/肌酐比值为9.1）和肾病综合征。活检证实为CFSGS。停用伊班膦酸1个月后无改善。开始使用泼尼松和他克莫司治疗，患者蛋白尿减少。
结论
对于发生伊班膦酸相关CFSGS的患者，如果早期识别该综合征并停用伊班膦酸，使用泼尼松和/或他克莫司治疗后蛋白尿似乎至少部分可逆。
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