Traitement du cancer: comment affecte-t-il les reins?
Kidney cancer is the third most common malignancy of the urinary tract, mostly affects older men and is among the 10 most common cancers that affect adults.
Can some chemotherapy drugs harm the kidneys?
Certainly, some chemotherapy drugs may be nephrotoxic and may cause acute renal failure or even chronic renal failure after a while. This occurs by causing damage to kidney cells (which is the most common cause), by reducing blood flow to the kidneys, or by damaging the kidney tissue that surrounds the glomeruli and tubules.
Are there any risk factors that increase the likelihood of acute kidney injury (AKI) from chemotherapy?
Yes, AKI caused by chemotherapy is more common in females and individuals:
- over 65 years of age
- with previous CKD
- with diabetes mellitus
- with heart failure
- with multiple myeloma
- with concomitant use of non-steroidal anti-inflammatory drugs
- with signs of dehydration
Which drugs can cause kidney failure?
Platinum, methotrexate and cyclophosphamide are the most well-known, without being the only ones. Platinum is nephrotoxic especially if the patient is dehydrated since it can cause acute renal damage initially by lowering blood flow and then by damaging the kidney cells but also it can lead to electrolyte disorders such as low blood magnesium. Cyclophosphamide, in addition to kidney damage, may also be responsible for bleeding cystitis or urinary condensation disorders. Ifosfamide may cause tubular lesions and hematuria. Methotrexate causes renal damage due to the sedimentation of the drug in the kidney but also directly affecting the tubules toxically.
Is there a way to reduce the risk of renal damage due to chemotherapy?
Clearly, the oncologist's level of attention to possible complications from the kidneys is particularly high. Patients with these risk factors are closely monitored to greatly reduce the complication rate. Adequate hydration is one of the main measures against AKI is and in general, hydration and electrolyte levels are monitored continuously during treatment. In addition to some chemotherapeutics, there are some medicines that protect the body from the complications of chemotherapy. A «friendlier» type of chemotherapy drug for the kidneys is selected and the dose is adjusted according to the renal function. Moreover, in the case of CKD, another chemotherapy drug is used that is not excreted by the kidneys. Finally, another process that promotes the protection of the kidneys is the alkalization of urine (the conversion of urine from acidic to alkaline).
By the Scientific Director Aristides Paraskevopoulos
1. Gunes S, Sahinturk V, Uslu S, Ayhanci A, Kacar S, Uyar R. Protective Effects of Selenium on Cyclophosphamide-Induced Oxidative Stress and Kidney Injury. Biol Trace Elem Res. 2017 Dec 30. doi: 10.1007/s12011-017-1231-8. [Epub ahead of print] PubMed PMID: 29290051.
2. George B, Joy MS, Aleksunes LM. Urinary protein biomarkers of kidney injury in patients receiving cisplatin chemotherapy. Exp Biol Med (Maywood). 2018 Feb;243(3):272-282. doi: 10.1177/1535370217745302. Epub 2017 Dec 12.
3. Hosohata K, Washino S, Kubo T, Natsui S, Fujisaki A, Kurokawa S, Ando H, Fujimura A, Morita T. Early prediction of cisplatin-induced nephrotoxicity by urinary vanin-1 in patients with urothelial carcinoma. Toxicology. 2016 Jun 1;359-360:71-5. doi: 10.1016/j.tox.2016.06.011. Epub 2016 Jun 16. PubMed PMID
4. Malyszko J, Kozlowska K, Kozlowski L, Malyszko J. Nephrotoxicity of anticancer treatment. Nephrol Dial Transplant. 2017 Jun 1;32(6):924-936. doi: 10.1093/ndt/gfw338. Review. PubMed PMID: 28339935.
5. Cosmai L, Gallieni M, Porta C. Renal toxicity of anticancer agents targeting HER2 and EGFR. J Nephrol. 2015 Dec;28(6):647-57. doi: 10.1007/s40620-015-0226-9. Epub 2015 Sep 4. Review. PubMed PMID: 26341657.
6. Perazella MA, Izzedine H. New drug toxicities in the onco-nephrology world. Kidney Int. 2015 May;87(5):909-17. doi: 10.1038/ki.2015.30. Epub 2015 Feb 11. Review. PubMed PMID: 25671763.
7. Nussbaum EZ, Perazella MA. Update on the nephrotoxicity of novel anticancer agents . Clin Nephrol. 2018 Mar;89(3):149-165. doi: 10.5414/CN109371. PubMed PMID: 29350175.
8. Izzedine H, Perazella MA. Anticancer Drug-Induced Acute Kidney Injury. Kidney Int Rep. 2017 Feb 16;2(4):504-514. doi: 10.1016/j.ekir.2017.02.008. eCollection 2017 Jul. Review. PubMed PMID: 29318217; PubMed Central PMCID: PMC5720534.
9. Sharbaf FG, Farhangi H, Assadi F. Prevention of Chemotherapy-Induced Nephrotoxicity in Children with Cancer. Int J Prev Med. 2017 Oct 5; 8:76. doi: 10.4103/ijpvm.IJPVM_40_17. eCollection 2017. Review. PubMed PMID: 29114374; PubMed Central PMCID: PMC5651649.