European Journal of Breast Health (Jul 2007)
A NEPHROLOGIST’S VIEW TO RENAL SAFETY OF BISPHOSPHONATES
Abstract
A variety of renal diseases and electrolyte disorders may be associated with malignancy or its treatment. The spectrum of disease in this setting includes acute renal failure (ARF), chronic renal failure, and tubular disorders.Chemotherapeutic agents as well as non-chemotherapeutic drugs can affect the glomerulus, tubules, interstitium or the renal microvasculature, with clinical manifestations that range from an asymptomatic elevation of serum creatinine to acute renal failure requiring dialysis. Fortunately, these complications are often preventable or reversible with prompt diagnosis and treatment.Bisphosphonates are a valuable class of non-chemotherapeutic drugs with potent anti-resorptive actions that make them ideal for treating metastatic bone disease. And they are widely used to treat skeletal complications of malignancy. Expanding indications for use in cancer patients warrant careful review of the renal toxicities associated with this medication class. In addition to their effi cacy, renal insuffi ciency during bisphosphonate therapy were reported. In considering its incidence rates and skeletal metastasis potential, breast cancer is particularly important for this subject.Renal failure remains an important complication of cancer and its treatment. The spectrum of cancer-associated renal disease has changed in the past 20 years, in large part as a result of the use of newer chemotherapy regimens. Early diagnosis and treatment of renal failure is vital—both to improve renal outcomes and to ensure that patients are best prepared for further oncologic treatment. Close cooperation with oncology colleagues is essential to improve outcomes in these complex patients.
