Massive proteinuria and acute renal failure after oral bisphosphonate (alendronate) administration in a patient with focal segmental glomerulosclerosis

• Published in: Clinical and experimental nephrology Vol. 13; no. 1; pp. 85 - 88
• Main Authors: Miura, Naoto, Mizuno, Natsuko, Aoyama, Ryuhei, Kitagawa, Wataru, Yamada, Harutaka, Nishikawa, Kazuhiro, Imai, Hirokazu
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-02-2009; Springer Nature B.V
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - therapy; Administration, Oral; Alendronate - administration & dosage; Alendronate - adverse effects; Blood Component Removal; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - adverse effects; Case Report; Glomerulosclerosis, Focal Segmental - complications; Glomerulosclerosis, Focal Segmental - drug therapy; Glomerulosclerosis, Focal Segmental - pathology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Nephrotic Syndrome - chemically induced; Nephrotic Syndrome - therapy; Osteoporosis - chemically induced; Osteoporosis - prevention & control; Proteinuria - chemically induced; Proteinuria - therapy; Renal Dialysis; Steroids - adverse effects; Treatment Outcome; Urology; Bisphosphonate; Nephrotic syndrome; Focal segmental glomerulosclerosis; Acute renal failure
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-008-0078-x

A 61-year-old Japanese man with nephrotic syndrome due to focal segmental glomerulosclerosis was initially responding well to steroid therapy. The amount of daily urinary protein decreased from 15.6 to 2.8 g. Within 14 days of the oral bisphosphonate (alendronate sodium) administration, the amount of daily urinary protein increased rapidly up to 12.8 g with acute renal failure. After discontinuing the oral alendronate, the patient underwent six cycles of hemodialysis and four cycles of LDL apheresis. Urinary volume and serum creatinine levels recovered to the normal range, with urinary protein disappearing completely within 40 days. This report demonstrates that not only intravenous, but also oral bisphosphonates can aggravate proteinuria and acute renal failure.