Renal Toxicities of Chemotherapy

doi:10.1053/j.seminoncol.2005.11.011

Seminars in Oncology

Volume 33, Issue 1, February 2006, Pages 68-73

https://doi.org/10.1053/j.seminoncol.2005.11.011 Get rights and content

Chemotherapeutic agents can produce a variety of acute and chronic organ toxicities. Since many antitumor drugs and their metabolites are cleared renally, the kidneys are vulnerable to injury. The drugs involved will determine the site of injury within the kidney, resulting in clinical manifestations ranging from an asymptomatic rise in serum creatinine to acute renal failure. The most common renal toxicities of chemotherapeutic agents are described.

Section snippets

Evaluation of Renal Function

An assessment of renal function is desirable to evaluate the effects of the chemotherapeutic agents and also essential in dosing renally excreted drugs with a narrow therapeutic index such as cancer chemotherapy. Ideally, a bedside method for estimation of the renal function is required. In humans, the assessment of renal function and its changes is limited to the measurement of the glomerular filtration rate (GFR), renal blood flow, and the estimation of proteinuria. GFR is the best clinical

Risk Factors

Several factors can potentiate renal dysfunction and contribute to the nephrotoxic potential of antineoplastic drugs. Since cancer is still a disease of the elderly, known to use many drugs, the concomitant use of nonchemotherapeutic nephrotoxic drugs (eg, nonsteroidal anti-inflammatory drugs) in combination with intrinsic renal diseases that are idiopathic, related to other comorbidities like hypertension, diabetes mellitus, and heart failure, might contribute to the induction of renal

Cisplatin

Cisplatin is widely used in the treatment of a large number of malignancies, and its introduction revived the significant clinical problem of nephrotoxicity caused by heavy metals. This obstacle to its clinical use has been so profound that it resulted in the synthesis of many analogs in the search for a less nephrotoxic compound. Cisplatin-induced nephrotoxicity has been shown to be dose-related in both animals and humans. Single drug doses of less than 50 mg/m² usually cause little renal

Conclusion

Although substantial progress has been made over the last decade to reduce hematological side effects and new generation antiemetics have been introduced, less progress has been made in the prevention of renal toxicity of chemotherapeutic agents. Different types of agents tested for protection against drug-induced major organ failure have shown encouraging results in preclinical experiments. It is hoped these agents will enter clinical trials and prove valuable in diminishing toxicity in

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Renal Toxicities of Chemotherapy

Section snippets

Evaluation of Renal Function

Risk Factors

Cisplatin

Conclusion

Am J Med

Ann Oncol

Kidney Int

Semin Nephrol

Eur J Cancer Clin Oncol

Pharmacol Res

Pharmacol Res

Toxicology

Ann Oncol

Semin Oncol

Am J Med

How to assess glomerular function and damage in humans

J Hypertens

Cisplatin nephrotoxicity

Cancer Chemother Pharmacol

Differential effects of cisplatin in proximal and distal renal tubule epithelial cell lines

Br J Cancer

Long-term effects of chemotherapy in patients with testicular cancer

J Clin Oncol

Anticancer drug-induced kidney disorders

Drug Saf

Renal salt wasting in patients treated with cisplatin

Ann Intern Med

Cisplatin-associated hemolytic-uremic syndrome

Cancer

High dose cisplatinum diammine dichloride. Amelioration of renal toxicity by mannitol diuresis

Cancer

Prevention of cisplatin-induced nephrotoxicosis in dogs, using hypertonic saline solution as the vehicle of administration

Am J Vet Res

High-dose cisplatin in hypertonic saline

Ann Intern Med

Reduced antineoplastic activity in mice of cisplatin administered with high salt concentration in the vehicle

J Natl Cancer Inst

A small increase in the Na ion concentration inhibits cisplatin toxicity in culture

Proc Am Assoc Cancer Res

Prevention of cisplatin-induced nephrotoxicity by methimazole

Pharmacol Res