Renal Toxicity

Side effects and toxicity of chemotherapy drugs remain the most important barriers to usage of higher doses of these agents, and possibly a reduction in their efficacy. Certain drugs can damage the kidneys, especially if used in excessive amounts. These are:

A few of the other drugs can have a minimal adverse effect on the kidneys, but not as severe or as common as the above medicines.

Kidney toxicity of Cisplatinum limits the total dose of the medicine that could be used safely. Those patients who are to start on Cisplatinum may have to be evaluated for the possibility of preexisting kidney problems. The best test to evaluate the kidneys is analysis of blood and urine. Patients with a prior history of kidney condition may not be candidates for treatment with this medicine.

In order to prevent the kidney damage, patients must be treated with fluids (hydration) before and after administration of Cisplatinum. They should also receive Lasix ( to increase the urine flow from the kidneys) prior to chemotherapy with Cisplatinum. An approach to prevent the cardiac side effects of Cisplatinum has led to the development of Liposomal packaged medicines.

Methotrexate, if used in high doses, or if used over a long period of time, may cause the same kind of kidney damage. The foregoing measures should also be taken prior to administration of high dose Methotrexate. The other drugs can also cause kidney disturbances.

Signs and Symptoms:

Some patients, despite proper management, may develop kidney damage from these drugs. They may experience:

Abnormal blood tests (kidney function tests)
Shortness of breath
Cough
Loss of energy
Irregular heartbeat

Diagnosis:

A simple blood test can disclose the diagnosis of kidney damage.

Treatment of the kidney problems:

The causal chemotherapy drug has to be stopped. Patients may have to be hospitalized and treated with appropriate medicines, hydration. Normally, kidneys recover from this side effect. In very severe cases, kidney dialysis may become necessary.