Intravenous therapy with a bisphosphonate can result in nephrotoxicity. Perazella and Markowitz identified risk factors for this avoidable complication. The authors are from Yale and Columbia Universities.


Patterns of nephrotoxicity:

(1) acute tubular necrosis

(2) focal segmental glomerulosclerosis (FSGS)


Risk factors for nephrotoxicity:

(1) excessive dose of the bisphosphonate, including failure to adjust the dose for pre-existing chronic renal disease

(2) failure to monitor serum creatinine prior to each intravenous dose

(3) failure to withhold therapy from someone with renal insufficiency


Additional risk factors to consider:

(1) concurrent therapy with other nephrotoxic drugs


To read more or access our algorithms and calculators, please log in or register.