Case report of progressive renal dysfunction as a consequence of amiodarone-induced phospholipidosis

Abstract

Background: Amiodarone is associated with a range of unwanted effects on pulmonary, thyroid, and liver function. However, the nephrotoxic side effect caused by renal phospholipidosis has hardly received any attention up to now.

Case summary: This is a case of an 86-year-old Caucasian male with an acute on chronic kidney disease 4 months after the initiation of amiodarone. A renal biopsy demonstrated the intracellular accumulation of phospholipids that have previously been demonstrated in association with organ dysfunction because of amiodarone use. Serum creatinine levels subsequently improved from 388 to 314 µmol/L after stopping amiodarone over the course of 2 months.

Discussion: In this case, a diagnosis of partially reversible acute on chronic kidney disease caused by lysosomal phospholipidosis due to amiodarone use was deemed highly likely. Lysosomal dysfunction leads to the accumulation of intra-lysosomal phospholipids (phospholipidosis). This accumulation is accompanied by progressive organ damage and dysfunction, including renal dysfunction, in rare instances. Guidelines advise regular surveillance for liver, lung, and thyroid toxicity during amiodarone treatment but do not mention the potential for renal toxicity. This case suggests that it might be prudent to include screening for renal toxicity in this surveillance.

Keywords: Amiodarone; Case report; Drug-related renal dysfunction; Phospholipidosis; Renal toxicity.

Figure 1

Sclerotic glomerulus showing extensive global hyalinized glomerulosclerosis (red arrow). The other glomerulus (blue arrow) shows segmental sclerosis (green arrow) and a hyalinized hilar arteriolae (periodic acid-schiff stain with diastase, 200x magnification).

Figure 2

Electron microscopy images showing multiple zebra bodies and myelin figures and also a thickening/splitting of the glomerular basement membrane.