Concepción-Zavaleta Marcio, Ramos-Torres Guillermo, Quiroz-Aldave Juan, Del Carmen Durand-Vásquez María, Ildefonso-Najarro Sofía, de Jesús Alvarado-León Elena, Zavaleta-Gutiérrez Francisca, Concepción-Urteaga Luis, Paz-Ibarra José
Universidad Científica del sur, Lima, Perú.
Division of Emergency Medicine, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú.
Caspian J Intern Med. 2024 Sep 7;15(4):743-747. doi: 10.22088/cjim.15.4.743. eCollection 2024 Fall.
Ifosfamide-induced Fanconi syndrome is a relatively infrequent complication that generally occurs in young patients with a high cumulative dose of ifosfamide; and is commonly characterized by glycosuria, proteinuria, electrolyte abnormalities, and a normal anion gap metabolic acidosis.
In this study, we present the case of a 16-year-old male patient with of osteosarcoma of the right femur with pulmonary metastasis, who received ifosfamide as part of chemotherapy 1 year and 2 months ago and required hospitalization for cellulitis. During inpatient management, he presented with hypokalemia, hypophosphatemia, polyuria, glycosuria, and proteinuria, by which he was diagnosed with Fanconi syndrome and nephrogenic diabetes insipidus, induced by ifosfamide. Management was focused on the control of the internal environment and use of potassium supplements and potassium-sparing diuretics.
Patients receiving ifosfamide should be periodically monitored for kidney function and internal environment to detect any potential complications. It is thus important to carefully observe the cumulative dose of ifosfamide to prevent its associated nephrotoxicity, since its appearance can impoverish the prognosis in patients with neoplasms. Therefore, physicians should always be aware about the possibility of nephrotoxicity development.
异环磷酰胺诱导的范科尼综合征是一种相对罕见的并发症，通常发生在接受高累积剂量异环磷酰胺的年轻患者中；其常见特征为糖尿、蛋白尿、电解质异常以及正常阴离子间隙代谢性酸中毒。
在本研究中，我们报告了一名16岁男性骨肉瘤患者，右股骨骨肉瘤伴肺转移，1年零2个月前接受异环磷酰胺化疗，因蜂窝织炎入院治疗。在住院治疗期间，他出现低钾血症、低磷血症、多尿、糖尿和蛋白尿，据此诊断为异环磷酰胺诱导的范科尼综合征和肾性尿崩症。治疗重点在于控制内环境以及使用补钾剂和保钾利尿剂。
接受异环磷酰胺治疗的患者应定期监测肾功能和内环境，以发现任何潜在并发症。因此，仔细观察异环磷酰胺的累积剂量以预防其相关肾毒性非常重要，因为其出现会使肿瘤患者的预后变差。所以，医生应始终意识到发生肾毒性的可能性。
