Pemetrexed-induced acute renal failure, nephrogenic diabetes insipidus, and renal tubular acidosis in a patient with non-small cell lung cancer.

We report a patient with metastatic non-small cell lung cancer who developed renal toxicities manifest as acute renal failure associated with nephrogenic diabetes insipidus and distal renal tubular acidosis following sequential therapy with pemetrexed. The nephrotoxicity occurred concomitantly with severe myelosuppression. We postulate renal tubular toxicity may account for distinct patterns of injury including acute renal failure and tubular cell dysfunction of the distal nephron.