Renal and pulmonary late effects of cancer therapy

Both the kidneys and lungs are susceptible to the toxic effects of cancer therapy, with specific chemotherapy agents, as well as radiation therapy, leading to acute toxicities and the risk for long-term dysfunction. The kidneys also are vulnerable to the direct impact of the cancer itself and to supportive care drugs such as certain anti-infectives and immunosuppressive agents, nonsteroidal anti-inflammatories, and radiocontrast media. The lungs are especially vulnerable after hematopoietic stem cell transplantation (HSCT), particularly in patients who develop chronic graft-versus-host disease. This article will discuss the epidemiology, specific risk factors, pathogenesis, natural history, recommended screening, preventive strategies, treatment, and areas for future research into renal and pulmonary toxicity in survivors of cancer.