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Esposito P, Domenech MV, Serpieri N, et al. Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis. World J Nephrol. 2017;6(4):217-220doi: 10.5527/wjn.v6.i4.217.
Esposito, P., Domenech, M. V., Serpieri, N., Calatroni, M., Massa, I., Avella, A., La Porta, E., Estienne, L., Caramella, E., & Rampino, T. (2017). Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis. World journal of nephrology, 6(4), 217-220. https://doi.org/10.5527/wjn.v6.i4.217
Esposito, Pasquale, et al. "Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis." World journal of nephrology vol. 6,4 (2017): 217-220. doi: https://doi.org/10.5527/wjn.v6.i4.217
Esposito P, Domenech MV, Serpieri N, Calatroni M, Massa I, Avella A, La Porta E, Estienne L, Caramella E, Rampino T. Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis. World J Nephrol. 2017 Jul 06;6(4):217-220. doi: 10.5527/wjn.v6.i4.217. PMID: 28729970; PMCID: PMC5500459.
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World J Nephrol. 2017 Jul 06;6(4):217-220. doi: 10.5527/wjn.v6.i4.217.

Severe cyclophosphamide-related hyponatremia in a patient with acute glomerulonephritis.

World journal of nephrology

Pasquale Esposito, Maria Valentina Domenech, Nicoletta Serpieri, Marta Calatroni, Ilaria Massa, Alessandro Avella, Edoardo La Porta, Luca Estienne, Elena Caramella, Teresa Rampino

Affiliations

  1. Pasquale Esposito, Maria Valentina Domenech, Nicoletta Serpieri, Marta Calatroni, Ilaria Massa, Alessandro Avella, Edoardo La Porta, Luca Estienne, Elena Caramella, Teresa Rampino, Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico "San Matteo" and University of Pavia, 27100 Pavia, Italy.

PMID: 28729970 PMCID: PMC5500459 DOI: 10.5527/wjn.v6.i4.217

Abstract

Cyclophosphamide is frequently used to treat cancer, autoimmune and renal diseases, such as rapidly progressive glomerulonephritis. Its side effects are well-known, including bone marrow depression, infections, alopecia, sterility, bladder malignancy and hemorrhagic cystitis. Moreover, in some cases cyclophosphamide use has been related to the onset of hyponatremia, by development of a syndrome of inappropriate antidiuresis. Indeed, severe hyponatremia has been previously reported in patients treated with high-dose or moderate-dose of intravenous cyclophosphamide, while only few cases have been reported in patients treated with low dose. Here, we discuss a case of a syndrome of inappropriate antidiuresis followed to a single low-dose of intravenous cyclophosphamide in a patient with a histological diagnosis of acute glomerulonephritis, presenting as acute kidney injury. After cyclophosphamide administration (500 mg IV), while renal function gradually improved, the patient developed confusion and headache. Laboratory examinations showed serum sodium concentration dropped to 122 mmol per liter associated with an elevated urinary osmolality of 199 mOsm/kg, while common causes of acute hyponatremia were excluded. He was successfully treated with water restriction and hypertonic saline solution infusion with the resolution of the electrolyte disorder. This case, together with the previous ones already reported, highlights that electrolyte profile should be strictly monitored in patients undergoing cyclophosphamide therapy in order to early recognize the potentially life-threatening complications of acute water retention.

Keywords: Antidiuretic hormone; Cyclophosphamide; Glomerulonephritis; Hypertonic solutions; Hyponatremia; Syndrome of inappropriate antidiuresis; Urine osmolality

Conflict of interest statement

Conflict-of-interest statement: All the authors have no conflicts of interests to declare.

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