Lenalidomide
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Fanconi syndrome (first report) in an elderly patient: case report A 69-year-old man developed reversible Fanconi syndrome during treatment with lenalidomide for refractory IgG λ multiple myeloma. The man started receiving lenalidomide 15 mg/day. Three weeks later, he presented to the hospital with weakness, fatigue, thirst, polyuria and orthostatic symptoms. He had upright and supine BP values of 83/45mm Hg and 110/79mm Hg, respectively. Laboratory investigations revealed acute renal failure, hypokalaemia, hypernatraemia, hypouricaemia, hypophosphataemia and metabolic acidosis; he had a serum pH of 7.29 and an anion gap of 7. He had a serum bicarbonate level of 15 mg/dL and a serum creatinine level of 2.7 mg/dL (22 and 1.7 mg/dL at initiation of lenalidomide, respectively). Urinalysis revealed glucosuria, with a normal serum glucose level, and a pH of 7; 1.8g of protein was found on 24-hour urine collection, and he had a urine osmolality of 128 mOsml/kg. In the first 24 hours after admission, he had a urine output of 6.1L. He had a fractional excretion of phosphate of 65.5%, and of sodium of 4.33%. His 24-hour potassium excretion was 70 mEq. The man received aggressive electrolyte and bicarbonate supplementation for hydration. He had an improvement in electrolyte abnormalities, and a decrease in urine output over several days. Twelve days after admission, he was discharged with oral potassium, bicarbonate and phosphorus supplementation. At 2-month follow-up, the electrolyte abnormalities had resolved and he discontinued oral supplementation. His glucosuria resolved and his renal function improved. Author comment: "To date, no cases implicating lenalidomide as a causative agent of [Fanconi syndrome] have been reported." Glezerman IG, et al. Reversible Fanconi syndrome due to lenalidomide. NDT Plus 801117285 1: 215-217, No. 4, Aug 2008 - USA
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous reports of Fanconi syndrome associated with lenalidomide. The WHO Adverse Drug Reaction database contained no reports of renal tubular disorder associated with lenalidomide.
0114-9954/10/1215-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 16 Aug 2008 No. 1215
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