Alendronate Associated Minimal Change Disease

Special Article - Hypotension

Austin J Nephrol Hypertens. 2019; 6(1): 1079.

Alendronate Associated Minimal Change Disease

Chenna S1¹, Tindni A¹, Puri V¹ and Chippa MV²*

¹Nephrology associates of Greater Cincinnati, USA

²Mercy Health West Hospital, Hospital Medicine, USA

*Corresponding author: Chippa MV, Hospital Medicine, Mercy West hospital, 3300 Mercy Health Blvd, Cincinnati, Ohio, USA

Received: December 24, 2018; Accepted: January 30, 2019; Published: February 06, 2019


Kidney injury associated with bisphosphonates is well known in literature, though it is more common with intravenous bisphosphonates. Case reports about focal segmental glomerulosclerosis are reported with oral and intravenous bisphosphonates. We present a case of 87-year-old female with acute renal failure and volume overload found to have minimal change disease on biopsy while on Alendronate for a period of four months. She has failed oral prednisone treatment and is now dependent on hemodialysis. This is probably the first case report of minimal change disease with oral bisphosphonates.

Keywords: Alendronate; Minimal change disease; Hemodialysis; Acute renal failure


MM: Milli Meters; HG: Mercury; g/dl: Grams Per Deciliter; LPF: Low Power Field; WBC: White Blood Cell; HPF: High Power Field; RBC: Red Blood Cell; HIV: Human Immunodeficiency Virus; ANA: Anti Nuclear Antibody; pANCA: perinuclear Anti Neutrophil Cytoplasmic Antibody; GBM: Glomerular Basement Membrane; Ab: Antibody; PO: Per Oral


Bisphosphonates related kidney disease is well documented in various clinical reports [1,2]. Its commonly seen with intravenous Pamidronate, and the most common kidney pathology is focal segmental glomerulosclerosis and less commonly acute tubular necrosis [1,3,4]. The clinical course is unpredictable [2,5]. Here we present a case of 87-year-old female who was on oral Alendronate and no known kidney disease presenting with progressive shortness of breath and weight gain for 3-4 weeks and was found to be in severe acute renal failure and her kidney biopsy showed minimal change disease and acute tubular necrosis. She was started on high dose prednisone and hemodialysis for uremia. This case suggests, the importance of monitoring kidney function and proteinuria in patients who are on bisphosphonates.

Case Presentation

An 87-year-old female with past medical history of hypertension, diabetes mellitus type 2, hyperlipidemia, asthma and hypothyroidism presented to emergency room for the evaluation of progressive swelling in legs associated with shortness of breath and weight gain over 3-4 weeks. At presentation, her blood pressure was 150/68 mm of Hg, and her physical examination showed diffuse anasarca, distended neck veins and crackles in both the lungs. Her blood urea nitrogen/ serum creatinine was 92/3.7 compared to 26/1.2 a month ago. Her serum albumin was 4 g/dl and Urinalysis showed 3 casts/lpf, 303 wbc/ hpf, negative blood, 2 rbc/hpf, no glucose. Urine protein to creatinine ratio was 4.79 mg/g. Previous urinalysis was negative for proteinuria. Her creatinine continued to worsen and reached to a peak of 7.7 mg/ dl in 48 hours. A complete workup for nephrotic syndrome was done. She was tested negative for HIV, hepatitis B and C. Her autoimmune work including complement levels, ANA and pANCA were normal. Anti GBM Ab was negative as well.

She underwent left kidney biopsy, it had 38 glomeruli. It showed minimal change disease, global glomerulosclerosis with acute tubular necrosis and interstitial fibrosis (Figures 1 & 2).

Citation: Chenna S, Tindni A, Puri V and Chippa MV. Alendronate Associated Minimal Change Disease. Austin J Nephrol Hypertens. 2019; 6(1): 1079.