Search

Intravenous bisphosphonate therapy is used to prevent fractures in the management of bone metastasis. However, it may induce renal damage. We herein report an 81-year-old woman with Fanconi syndrome and osteomalacia who had been diagnosed with metastatic breast cancer and received treatment with zolendronate for over 5 years. Her bone markers normalized after switching zolendronate to denosmab and starting vitamin D and mineral supplementation. This case shows that chronic renal damage induced by zolendronate can cause osteomalacia. In patients with intravenous zolendronate therapy, close monitoring of renal and bone markers is needed, even under long-term therapy.

The patient was a 75-year-old man who was admitted to our hospital because of fatigue, leg edema and heavy proteinuria. Due to his cloudy urine and elevated triglyceride level in his urine, he was diagnosed with chyluria. Tests for infectious disease were negative, and lymphoscintigraphy showed no blockage in the lymphatic system. He was therefore diagnosed with idiopathic chyluria. Hypothyroidism was also found and his cloudy urine and heavy proteinuria disappeared without dietary modifications after starting levothyroxine treatment for hypothyroidism. The patient is currently being followed up in an outpatient clinic and is doing well, with no recurrence of chyluria.

We report a case involving a 43-year-old Japanese woman with steroid-resistant focal segmental glomerular sclerosis (FSGS) and severe renal dysfunction, which was ameliorated by low-density lipoprotein apheresis (LDL-A). She had been treated with steroid therapy, but had experienced anuria for over 10 weeks and required hemodialysis. She was then treated with LDL-A, which resulted in improved urinary protein excretion and renal function. Her renal function recovered after 97 days of hemodialysis therapy. This case suggests that LDL-A may represent an effective rescue treatment in patients with FSGS and long-term anuria.