[Prevention and management of nephrotoxicity from anti-cancer agents]

Nephrotoxicity is an inherent adverse effect of certain anticancer drugs. Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes. This article reviews the prevention and management of anticancer drug-induced renal dysfunction. Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and hematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine.