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NDT Plus Advance Access published online on June 24, 2008
NDT Plus, doi:10.1093/ndtplus/sfn076
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Water intoxication induced by low-dose oral cyclophosphamide in a patient with anti-neutrophil cytoplasmic antibody-related glomerulonephritis

Akihiko Kato1, Takeshi Sugiura2, Tatsuo Yamamoto3, Taro Misaki4, Takayuki Tsuji4, Yukitoshi Sakao4, Masaaki Sakakima4, Hideo Yasuda4, Yoshihide Fujigaki4 and Akira Hishida4

1 Division of Blood Purification, Hamamatsu University School of Medicine
2 Department of Nephrology, Seirei Mikatahara General Hospital
3 Department of Health and Nutritional Science, Hamamatsu University
4 First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan

Correspondence: Akihiko Kato, Division of Blood Purification, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan. Tel. and Fax: +81-53-435-2756; E-mail: a.kato{at}hama-med.ac.jp


  Abstract

We reported the case of a 70-year-old woman with moderate renal failure due to anti-neutrophil cytoplasmic antibody-related glomerulonephritis who developed symptomatic water intoxication (serum Na: 108 mEq/L) following treatment with oral low-dose cyclophosphamide (CY) (50mg/day). Estimated glomerular filtration rate was 29.5 mL/min/1.73 m2. She had drunk >2 L of fluid in 12 h prior to the development of cerebral oedema. This rare case suggests that oral low-dose CY could be an occult cause of water intoxication in patients with chronic kidney disease taking large fluid volumes.

Key Words: chronic kidney disease • cyclophosphamide • fluid intake • symptomatic hyponatraemia

Received for publication April 15, 2008. Accepted for publication May 30, 2008.


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