Nephrotic proteinuria associated with high‐dose pamidronate in multiple myeloma

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Abstract
Summary. Five patients receiving increased dose or frequency of pamidronate beyond the recommended dose (90 mg/monthly) exhibited nephrotic proteinuria (range 3·96–24 g/24 h). On dose reduction or discontinuation, three of these patients showed decreased proteinuria to normal levels (< 1 g/24 h), and proteinuria decreased to 4·5 g/24 h from a peak of 24 g/24 h in one patient. One patient on haemodialysis (hence not evaluable) had proteinuria of 2 g/24 h and elevated creatinine levels. One other patient continued to show elevated creatinine levels (272·8 µmol/l). Renal biopsies obtained in two patients revealed focal segmental glomerulosclerosis.

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