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Abstract: FR-PO266

Ifosfamide-Induced Fanconi Syndrome: A Complication that Cannot Be Overlooked

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Alves, Italo Rafael Correia, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Xavier, Lucas Silva, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Valenca, Andrea C.E.P, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Costa, Denise Maria Do Nascimento, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Santos, Thais OC, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Gueiros, Ana Paula, Hospital das Clinicas, Recife, Pernambuco, Brazil

Fanconi syndrome (FS) is a severe dysfunction of the proximal tubule, which causes urinary loss of glucose, amino acids, phosphorus, bicarbonate and potassium. Ifosfamide (IFO)-induced FS is reported in 1.4-5% of children being treated for solid tumors, but few cases have been reported in adults. We describe a case of FS in an adult who was taking IFO for sarcoma treatment.

Case Description

A male, aged 29, diagnosed with cervical fibrosarcoma at the age of 13. In September 2021, with the third recurrence of the disease, he initiated chemotherapy (CT) with IFO, vincristine and actinomycin D. On the 24th week of CT, after 48g/m2 of IFO, the patient presented muscle weakness and renal dysfunction (Cr mg/dL 1.3), and CT was suspended. In September 2022, six months after interrupting CT, he was admitted with disabling muscle weakness (unable to walk) and polyuria (8.0 L/day). Laboratory: Cr 4.2; potassium (mEq/L) 2.6, phosphorus (mg/dL) 1.7, pH 7.19, bicarbonate (mEq/L) 13, chlorine 113 mEq/L, sodium 135 mEq/L, anion gap 12; urine: density 1007, glucose 4+ (normal blood glucose), no hematuria, 24h proteinuria 1.3 g/day, potassium in isolated sample 59 mEq/L and phosphorus excretion fraction 94%. After correcting electrolytes and metabolic acidosis, the patient’s weakness improved significantly, urine output normalized and Cr was 3.2. He is currently undergoing outpatient follow-up, using chelated phosphorus, potassium citrate, sodium bicarbonate and potassium chloride. January 2023 exams: Cr 3.3, phosphorus 3.2, potassium 4.6, bicarbonate 18.


IFO toxicity appears to be dose dependent and occurs mainly with cumulative doses greater than 45 g/m2. It is believed that IFO nephrotoxicity is due to the action of metabolites, acrolein and chloroacetaldehyde in the renal tubules. It is important that oncologists and nephrologists are aware of the possibility of FS and nephrogenic diabetes insipidus with the use of IFO, so as to avoid serious and fatal complications. Our patient presented muscle weakness and altered renal function, IFO was suspended, but FS was not diagnosed at the time. We emphasize the importance of monitoring renal function and electrolytes in cancer patients undergoing CT, mainly because a wide range of old and new drugs is available.