%0 Journal Article
%T Prolonged Recovery Time from Zoledronic Acid Induced Acute Tubular Necrosis: A Case Report and Review of the Literature
%A Frederic Rahbari-Oskoui
%A Odicie Fielder
%A Nima Ghasemzadeh
%A Randolph Hennigar
%J Case Reports in Nephrology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/651246
%X Acute tubular necrosis (ATN) due to bisphosphonates has been reported with Zoledronic acid but the time to recovery (if any) has been usually less than 4 months. Possible recovery time from ATN of any cause is usually less than 6 months. In this paper, we present the case of a 59-year-old Caucasian female with metastatic breast cancer who had received 16 monthly injections of Zoledronic acid for treatment of tumor induced hypercalcemia and developed several episodes of mild acute kidney injury which resolved by withholding treatment. Unfortunately, after the sixteenth injection, the patient experienced severe acute kidney injury, with a peak serum creatinine of 8.0£¿mg/dL. Although urinalysis showed muddy brown casts, because of atypical recovery time and presence of eosinophiluria and subnephrotic range proteinuria, a kidney biopsy was performed. Diagnosis of typical acute tubular necrosis was confirmed without any other concomitant findings. The course was remarkable for an unusually slow recovery of renal function over 15 months without need for renal replacement therapy until the patient expired from her metastatic cancer two years later. We reviewed all the published cases of acute kidney injury due to Zoledronic acid and suggest recommendations for clinicians and researchers. 1. Introduction The use of Zoledronic acid has been reported to cause acute tubular necrosis, but little is known about the particular features of this type of toxic tubular necrosis. 2. Case Report A 59-year-old Caucasian female with history of type II diabetes mellitus and hypertension was referred to the Emory Renal Clinic for evaluation of increased serum creatinine (SCr). The patient had hypertension for 7 years, type II diabetes mellitus known for 5 years without any documented complications, mild anemia, dyslipidemia, and a baseline SCr of 1.0£¿mg/dL about 6 months prior to referral. There was no recorded quantification of proteinuria or microalbuminuria since she had been diagnosed with diabetes. Her surgical history was only significant for tonsillectomy. She was single and had never been pregnant. Her medication list included stable doses of Lisinopril, Atenolol, and Pioglitazone. She denied any NSAID use. Her family history was negative for cancers, hypertension, diabetes, or chronic kidney disease. Social history was negative for alcohol, tobacco, or illicit drug abuse. She was a college graduate who worked as a microbiologist. The patient had been well until 2 years earlier, when she presented with posttraumatic bruising of her right breast. After resolution of the
%U http://www.hindawi.com/journals/crin/2013/651246/