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Review
. 2015 Jul 22:15:535.
doi: 10.1186/s12885-015-1536-y.

Collapsing focal segmental glomerulosclerosis following long-term treatment with oral ibandronate: case report and review of literature

Ning Jia  1 , Fionnuala C Cormack  2 , Bin Xie  3 , Zita Shiue  4 , Behzad Najafian  5 , Julie R Gralow  6
Affiliations
Review

Collapsing focal segmental glomerulosclerosis following long-term treatment with oral ibandronate: case report and review of literature

Ning Jia et al. BMC Cancer. .

Abstract

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.

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Figures

Fig. 1
Fig. 1
a A glomerulus with FSGS. The red arrow marks the segmentally sclerosed region with obliteration of capillary tuft, hyaline deposition and adhesion to Bowman’s capsule. Jones methenamine silver, 40x objective. b A glomerulus with collapsing variant of FSGS. There is almost diffuse collapse of capillary loops with proliferation of overlying epithelial cells (yellow arrow). Jones methenamine silver, 40x objective. c An electron micrograph shows extensive effacement of foot processes (black arrows) over a capillary loop (cap) with corrugated glomerular basement membrane. 4800 X magnification
See this image and copyright information in PMC

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