Abstract
We describe a case of collapsing focal segmental glomerulosclerosis and severe kidney dysfunction in a liver transplant recipient after the initiation of alendronate for osteopenia. In view of the increasing incidence of chronic kidney disease in long-term liver transplant patients, bisphosphonates need to be used with caution in these patients. The usefulness of bisphosphonates for the prevention of early bone loss after liver transplantation is increasingly reported. However, there is little information on the safety and efficacy of these drugs when used in the later stages of liver transplant, particularly in the presence of chronic kidney disease. Bisphosphonates are excreted unchanged via the kidneys after reaching the systemic circulation. Some cases of severe kidney injury, in particular collapsing focal segmental glomerulosclerosis, have been described that are associated with the use of pamidronate. Alendronate, a widely used bisphosphonate in transplant patients, has not been related to kidney toxicity. We describe a case of collapsing focal segmental glomerulosclerosis and severe kidney dysfunction in a liver transplant recipient soon after the initiation of alendronate for osteopenia. Possible pathogenetic mechanisms are discussed. In view of the increasing incidence of chronic kidney disease in long-term liver transplant patients, bisphosphonate need to be used with caution in patients with a low glomerular filtration rate.
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References
Leidig-Bruckner G, Hosch S, Dodidou P et al (2001) Frequency and predictors of osteoporotic fractures after cardiac or liver transplantation: a follow-up study. Lancet 357:342–347
Millonig G, Graziadei IW, Eichler D et al (2005) Alendronate in combination with calcium and vitamin D prevents bone loss after orthotopic liver transplantation: a prospective single-center study. Liver Transpl 11:960–966
Dodidou P, Bruckner T, Hosch S et al (2003) Better late than never? Experience with intravenous pamidronate treatment in patients with low bone mass or fractures following cardiac or liver transplantation. Osteoporos Int 14:82–89
Laurinavicius A, Hurwitz S, Rennke HG (1999) Collapsing glomerulopathy in HIV and non-HIV patients: a clinicopathological and follow-up study. Kidney Int 56:2203–2213
Markowitz GS, Appel GB, Fine PL et al (2001) Collapsing focal segmental glomerulosclerosis following treatment with high-dose pamidronate. J Am Soc Nephrol 12:1164–1172
Kunin M, Kopolovic J, Avigdor A et al (2004) Collapsing glomerulopathy induced by long-term treatment with standard-dose pamidronate in a myeloma patient. Nephrol Dial Transplant 19:723–726
Barri YM, Munshi NC, Sukumalchantra S et al (2004) Podocyte injury associated glomerulopathies induced by pamidronate. Kidney Int 65:634–641
Bounameaux HM, Schifferli J, Montani JP et al (1983) Renal failure associated with intravenous diphosphonates. Lancet 1:471
Yates AJ, Percival RC, Gray RE et al (1985) Intravenous clodronate in the treatment and retreatment of Paget’s disease of bone. Lancet 1:1474–1477
Dumon JC, Magritte A, Body JJ (1991) Efficacy and safety of the bisphosphonate tiludronate for the treatment of tumor-associated hypercalcemia. Bone Miner 15:257–266
Barisoni L, Kriz W, Mundel P et al (1999) The dysregulated podocyte phenotype: a novel concept in the pathogenesis of collapsing idiopathic focal segmental glomerulosclerosis and HIV-associated nephropathy. J Am Soc Nephrol 10:51–61
Sauter M, Julg B, Porubsky S et al (2006) Nephrotic-range proteinuria following pamidronate therapy in a patient with metastatic breast cancer: mitochondrial toxicity as a pathogenetic concept? Am J Kidney Dis 47:1075–1080
Markowitz GS, Fine PL, D’Agati VD (2002) Nephrotic syndrome after treatment with pamidronate. Am J Kidney Dis 39:1118–1122
Markowitz GS, Fine PL, Stack JI et al (2003) Toxic acute tubular necrosis following treatment with zoledronate (Zometa). Kidney Int 64:281–289
Giannini S, D’Angelo A, Carraro G et al (2001) Alendronate prevents further bone loss in renal transplant recipients. J Bone Miner Res 16:2111–2117
Jeffery JR, Leslie WD, Karpinski ME et al (2003) Prevalence and treatment of decreased bone density in renal transplant recipients: a randomized prospective trial of calcitriol versus alendronate. Transplantation 76:1498–1502
Shane E, Addesso V, Namerow PB et al (2004) Alendronate versus calcitriol for the prevention of bone loss after cardiac transplantation. N Engl J Med 350:767–776
Haagsma EB, Thijn CJ, Post JG et al (1988) Bone disease after orthotopic liver transplantation. J Hepatol 6:94–100
Meys E, Fontanges E, Fourcade N et al (1994) Bone loss after orthotopic liver transplantation. Am J Med 97:445–450
Pillebout E, Nochy D, Hill G et al (2005) Renal histopathological lesions after orthotopic liver transplantation. Am J Transplant 5:1120–1129
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Supported by FIS grant BA0690020 (JP) and NIH grant KO8-DK067981 (AD).
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Pascual, J., Torrealba, J., Myers, J. et al. Collapsing focal segmental glomerulosclerosis in a liver transplant recipient on alendronate. Osteoporos Int 18, 1435–1438 (2007). https://doi.org/10.1007/s00198-007-0361-9
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DOI: https://doi.org/10.1007/s00198-007-0361-9