Behandeling van kanker: Hoe beïnvloedt het de nieren?
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
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