Reversible acute renal failure following single administration of fludarabine

Fludarabine is a purine analogue with high activity in lymphoid malignancies and a frequent component of reduced-intensity conditioning regimens, due to its immunosuppressive properties. Renal toxicity of fludarabine occurs in less than 5% of patients,1 usually in the context of tumor lysis syndrome.2 In one case report of fludarabine-associated nephrotoxicity occurring after the administration of a cumulative dose of 500 mg/m2 of fludarabine, renal biopsy showed the presence of mesangiocapillary glomerulonephritis.3 Another report described the occurrence of crescentic glomerulonephritis, with p-ANCA positivity, after three courses of treatment with this drug.4 We report a case of acute renal failure developing after the first administration of fludarabine, without associated tumor lysis syndrome.