Growth retardation and osteomalacia as a result of ifosfamide nephrotoxicity in a 3-year-old boy whose genotype reveals the genes encoding glutathione S-transferases GSTM1 and GSTT1.

A case of a child with growth retardation and prolonged osteomalacia, as a result of chronic renal tubulopathy, following successful therapy for a sacral-coccygeal germinal tumour, is described. The male patient was enrolled into the research programme for the evaluation of the association between deletion of the genes encoding a number of classes of glutathione S-transferases (GST) and adverse reactions to alkylating agents. His genotype revealed the genes encoding glutathione transferase classes GSTM1 and GSTT1, but these enzymes did not provide adequate protection for the tubular cells, from the toxic effects of ifosfamide metabolites. Intense chemotherapy resulted in an increased risk of chronic side effects. Further studies are necessary for increased understanding of the inter-individual variability in the extent and nature of ifosfamide nephrotoxicity.