ISSN: 2251-8363    eISSN: 2251-8819  
J Nephropathol. 2017;6(2):43-48.
doi:10.15171/jnp.2017.07
PMID: 28491851
PMCID: PMC5418068

Scopus id: 85014843854

Case Report

Pemetrexed-induced acute kidney failure following irreversible renal damage: two case reports and literature review

Tito Zattera 1, Francesco Londrino 2 * , Matteo Trezzi 1, Roberto Palumbo 2, Antonio Granata 3, Paola Tatangelo 2, Valentina Corbani 1, Valeria Falqui 1, Nadia Chiappini 1, Lisa Mathiasen 4, Marco Cavallini 5, Davide Rolla 1

1 Unità Operativa Complessa, Nefrologia e Dialisi, Ospedale S. Andrea, La Spezia, Italy
2 Unità Operativa Complessa, Nefrologia e Dialisi, Ospedale S. Eugenio, Roma, Italy
3 Unità Operativa Complessa, Nefrologia e Dialisi, Ospedale S. Giovanni di Dio, Agrigento, Italy
4 Estor, Pero, Italy
5 Unità Operativa Complessa, Nefrologia e Dialisi, Ospedale di Dolo, Italy
*Corresponding author: Francesco Londrino MD, Unità Operativa Complessa, Nefrologia e Dialisi, Ospedale S. Eugenio, Viale dell’Umanesimo 10, 00144, Roma, Italy. Email: londrinofrancesco@libero.it

Abstract

Background: Pemetrexed (PEM) is a new-generation multitargeted antifolate agent with a demonstrated broad-spectrum activity in several types of human cancers, including non-small cell lung cancer (NSCLC) and mesothelioma. Major side effects include dose-limiting hematologic toxicities. PEM nephrotoxicity is well known; however, its frequency is considered to be low.

Case Presentation: Here we report two cases of acute kidney injury (AKI) related to PEM administration (500 mg/m2) in patients with NSCLC. The first patient required hemodialysis treatment and was submitted to renal biopsy which showed acute tubular damage and interstitial edema without acute tubular necrosis. No other potential nephrotoxic agents were identified. The second patient developed AKI, not proven by biopsy and did not require renal replacement therapy. Both patients, on regular supplementation with folic acid and vitamin B12, concomitantly developed myelosuppression and even several months after PEM withdrawal, showed only a modest improvement of renal function.

Conclusions: PEM is an antifolate antineoplastic agent with a broad-spectrum activity in locally advanced or metastatic NSCLC. It has been shown that PEM allows longer survival. The risk of acute or chronic kidney disease may be one of the prices to be paid for this success.

Implication for health policy/practice/research/medical education:

Pemetrexed (PEM) is an antifolate antineoplastic agent with a broad-spectrum activity in locally advanced or metastatic non-small cell lung cancer (NSCLC). It has been shown that PEM allows longer survival. The risk of acute or chronic kidney disease may be one of the prices to be paid for this success. This paper demonstrates that nephrologists and oncologists should collaborate to study tailored therapies in patients with cancer.

Please cite this paper as: Zattera T, Londrino F, Trezzi M, Palumbo R, Granata A, Tatangelo P, et al. Pemetrexed-induced acute kidney failure following irreversible renal damage: two case reports and literature review. J Nephropathol. 2017;6(2):43-48. DOI: 10.15171/jnp.2017.07.

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