Renal side effects of Ifosfamide in patients admitted for chemotherapy

Abstract

• BACKGROUND: Ifosfamide (IFO) is an alkylating cytostatic agent with nephrotoxic properties. Most often it causes disturbances in proximal tubular function manifesting as glycosuria, albuminuria, hyperphosphaturia with hypophosphatemia, tubular acidosis, and hypokalemia. Impairment of renal glomerular function is less frequent and manifests as reduced glomerular filtration or distal tubulopathy along with the symptoms of diabetes insipidus. A significant percentage of patients also develop neurotoxic side effects. The aim of this study was to assess the incidence of side effects in patients treated with IFO for neoplastic diseases.
• METHODS: This was a prospective study on all admitted patients that received Ifosfamide for chemotherapy. After full physical examination and performing necessary paraclinical examinations (sodium, potassium, calcium, BUN, creatinine, uric acid, SGOT, SGPT, bilirubin and ECG), information forms for all of them were filled out at admission and in follow up visits to be used in final assessment. Renal function was assessed at the beginning of chemotherap and then regularly during subsequent cycles.
• RESULTS: Sixty-six cases were male and 34 cases were female. Mean age was 36.4 years. Alopecia was recorded in 70 cases (70%) and nausea and vomiting in 43 cases (43%). Nephropathy (increased BUN and creatinine, gross hematuria, phosphaturia, glucosuria) was not observed in any patient. In 8 patients, microscopic hematuria was detected. Twentythree patients had bone marrow suppression, and 7 cases showed severe neutropenia and broad spectrum antibiotics were prescribed for them. I did not find any culture positive infection. Serum electrolyte imbalance, diarrhea and severe allergic reactions were not observed.
• CONCLUSIONS: Ifosfamide may potentially produce both mild and severe renal side effects. Side effects of IFO should be evaluated in different populations with different genomic profiles.
• KEYWORDS: Ifosfamide, nephropathy, side effects.