Podocyte Disease Following Treatment with Intravenous Ibandronate in an Older Patient

Ye Rin Chung; Hyun Soon Lee; Dong Young Lee; Sang Hee Lee; Jin Seon Jeong; Beom Kim

doi:10.4235/agmr.23.0195

Ann Geriatr Med Res > Accepted Articles

Case Report

DOI: https://doi.org/10.4235/agmr.23.0195 [Accepted]
Published online February 22, 2024.

Podocyte Disease Following Treatment with Intravenous Ibandronate in an Older Patient

Ye Rin Chung¹, Hyun Soon Lee², Dong Young Lee¹, Sang Hee Lee¹, Jin Seon Jeong¹, Beom Kim¹

¹Division of Nephrology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
²Hankook Renal Pathology Laboratory, Seoul, Republic of Korea

Correspondence: Beom Kim,
Email: monica3895@naver.com

Received: 2 December 2023 • Revised: 14 January 2024 • Accepted: 16 February 2024

Abstract

Bisphosphonates are commonly used to treat osteoporosis. While renal toxicity is common with pamidronate and zoledronate, few ibandronate-related cases are reported. We describe a rare case of ibandronate-associated nephrotoxicity. An 88-year-old woman was admitted for edema. She had been receiving intravenous ibandronate treatment for postmenopausal osteoporosis and had no other diagnosed diseases. She was presented with proteinuria, hypoalbuminemia (1.9 g/dL), and an elevated serum creatinine level (1.8 mg/dL). Renal biopsy revealed podocyte disease, favoring a diagnosis of focal segmental glomerulosclerosis. She was treated with diuretics, tacrolimus, and fimasartan. Steroids were avoided due to severe osteoporosis. Three months later, the edema had subsided and the laboratory findings had improved (serum albumin 3.5 g/dL, serum creatinine 0.97 mg/dL). This case emphasizes the importance of careful monitoring of proteinuria and renal function during ibandronate treatment. In older adult patients, kidney biopsy and immunosuppressive treatment may be considered based on physical activity and underlying diseases.

Key Words: Ibandronic acid, Postmenopausal osteoporosis, Nephrotic syndrome