Machado CE, Flombaum CD
Safety of pamidronate in patients with renal failure and
hypercalcemia
Clin Nephrol
(Mar) 45:175-179 1996

Machado and Flombaum report the use of pamidronate in 31 patients with
hypercalcemia of malignancy and serum creatinines ranging from 1.5 to 6.4
mg/dL. Patients received from 30 to 90 mg of intravenous pamidronate in
normal saline over at least 24 hours. Serum creatinine remained
unchanged or decreased in 25 patients. Four patients whose renal
function decreased after pamidronate had multiple myeloma, Bence- Jones
proteinuria, dehydration, and decreasing renal function before treatment
with pamidronate. Other patients with worsening renal function during
treatment had been given ibuprofen, ifosfamide, or had lower tract
obstruction. The serum calcium decreased in all but one patient.
Comment: Pamidronate, a biphosphonate, inhibits osteoclast-mediated
bone
reabsorption and is used to treat the hypercalcemia of malignancy. A
previous report of renal failure following rapid biphosphonate infusion
and nephrotoxicity in animals given large doses has caused concern over
the use of these drugs in patients with renal impairment. Machado and
Flombaum report that the slow infusion of pamidronate given with saline
hydration had little effect on renal function in most patients. Although
possibly explained by other factors, nearly 20 per cent of the patients
suffered a decrease in their renal function. Until larger groups are
studied showing efficacy and safety, biphosphonates should be given with
caution in patients with renal insufficiency. The authors
recommendations for slow biphosphonate infusion and adequate hydration
are prudent. (George R. Aronoff, M.D., University of Louisville)