A drug-induced transient Fanconi syndrome associated with pure red cell aplasia: pathophysiology of the electrolyte disorders
Yamaji, Y.; Uchida, S.; Miyajima, Y.; Kamane, S.; Ogata, E.
Nihon Jinzo Gakkai Shi 37(1): 44-48
1995
ISSN/ISBN: 0385-2385 PMID: 7699953 Document Number: 444518
A 55-year-old female with a long history of pure red cell aplasia temporarily manifested Fanconi syndrome with hypophosphatemia, hypouricemia, glycosuria, acidic amino aciduria, but not metabolic acidosis nor hypokalemia. These abnormalities completely resolved in 3-4 weeks after withdrawal of several drugs, suggesting that the cause of her Fanconi syndrome could be attributed to a drug or a combination of multiple drugs, though lymphocyte stimulating tests revealed negative results for all possible drugs. Postmortem specimen of her kidneys showed mild mesangial proliferation without significant changes in tubular and interstitial regions. Massive ferrous precipitations were found in the zona glomerulosa of the adrenal glands. The pathophysiology of Fanconi syndrome shown in the patient was likely to have been a drug-induced transient and mild dysfunction of the Na+/K+ pump of the renal proximal tubules, which might also explain the selective amino aciduria. The absence of hypokalemia corroborates well with both a lack of bicarbonaturia and hemochromatosis-induced adrenal insufficiency. Patients with a renal dysfunction associated with electrolyte derangements and without proteinuria or azotemia should be under vigilant observation when using many drugs.