Anastrozole-Associated Sclerosing Glomerulonephritis in a Patient with Breast Cancer

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Abstract

Objective: Anastrozole is a selective aromatase inhibitor and is used for the hormonal treatment of postmenopausal breast cancer. There are major side effects of anastrozole including decrease in both lumbar spine and total hip bone mineral density, increase in the incidence of all bone fractures (especially fractures of spine, hip and wrist), joint disorders and increase in the cholesterol level. Case Summary: We report a case of a 73-year-old postmenopausal woman with stage T2N0M0 breast cancer. Adjuvant chemotherapy was not indicated and anastrozole hormonotherapy was started. Diagnosis of sclerosing glomerulonephritis occurred in this patient during anastrozole use, suggesting a newly defined side effect of anastrozole. Discussion: Renal elimination is not a significant pathway of elimination for anastrozole, clearance of anastrozole is unchanged even in severe renal impairment. Dosing adjustment in patients with renal dysfunction is not necessary for anastrozole. We believe that the acute renal failure in our patient was associated with anastrozole. Renal injury due to anastrozole has not been published in the English literature. Conclusions: Anastrozole may be the causative factor in patients with sclerosing glomerulonephritis.

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Most cited references 8

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ATAC trial update

A. Howell (2005)

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Drug-induced acute kidney injury.

Miet Schetz, Joseph Dasta, Stuart Goldstein … (2005)

The purpose of this review is to describe the most prevalent mechanisms of drug-induced acute kidney injury, to define the risk factors for nephrotoxicity, and to analyze the available evidence for preventive measures. Drug toxicity remains an important cause of acute kidney injury that, in many circumstances, can be prevented or at least minimized by vigilance and early intervention. Recent studies have resulted in increased insight into the subcellular mechanisms of drug nephrotoxicity. Further improvement is to be expected from the identification of early markers of nephrotoxicity and an increasing involvement of a clinical pharmacist. The main mechanisms of nephrotoxicity are vasoconstriction, altered intraglomerular hemodynamics, tubular cell toxicity, interstitial nephritis, crystal deposition, thrombotic microangiopathy, and osmotic nephrosis. Before prescribing a potentially nephrotoxic drug, the risk-to-benefit ratio and the availability of alternative drugs should be considered. Modifiable risk factors should be corrected. The correct drug dosage should be prescribed. Patients should be pre-hydrated and the glomerular filtration rate should be frequently monitored during the administration of a potentially nephrotoxic drug. Studies are needed to further elucidate the mechanisms of nephrotoxicity to design more-rational prevention and treatment strategies. Computer-based prescriber-order entry and an appropriately trained intensive care unit pharmacist are particularly helpful to minimize medication errors and adverse drug events.

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Anastrozole-induced hepatotoxicity.

Leire Zubiaurre Lizarralde, Alberto Piérola, Luis Bujanda … (2006)

We present a case of hepatotoxicity induced by an aromatase-inhibiting hormonal antineoplastic drug (anastrazol) in an elderly woman. This is the first reported case in the literature.

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Author and article information

Journal

Journal ID (publisher-id): OCL

Journal ID (nlm-ta): Oncology

Journal ID (doi): 10.1159/issn.0030-2414

Title: Oncology

Publisher: S. Karger AG

ISSN (Print): 0030-2414

ISSN (Electronic): 1423-0232

Publication date Subscription-year: 2007

Publication date (Print): June 2008

Publication date (Electronic): 02 June 2008

Volume: 73

Issue: 5-6

Pages: 415-418

Affiliations

^aDepartment of Medical Oncology, Medical Faculty, Gaziantep University, and Gaziantep Oncology Hospital, Departments of ^bPathology and ^cNephrology, Medical Faculty, Gaziantep University, Gaziantep, Turkey

Article

Publisher ID: 136797 Other ID: Oncology 2007;73:415–418

DOI: 10.1159/000136797

PubMed ID: 18515982

SO-VID: f5ae56cf-ab8e-4653-8afa-98362ad0a9a0

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 28 November 2007

Date accepted : 28 November 2007

Page count

Figures: 1, References: 18, Pages: 4

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