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Cancer drugs and acute kidney injury: new therapies and new challenges
Ittamar Gork1, Fei Xiong, Abhijat Kitchlu
1Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Purpose Of Review:
Cancer therapies continue to evolve at a rapid pace and although novel treatments, including immunotherapies and targeted therapies have allowed for substantial improvements in cancer survival, they carry associated risks of acute kidney injury (AKI). We aim to summarize the existing literature on AKI associated with the spectrum of systemic cancer treatments, including conventional chemotherapies, newer immunotherapies, and the growing number of targeted cancer therapies, which may be associated with both AKI and 'pseudo-AKI'.
Recent Findings:
Conventional cytotoxic chemotherapies (e.g. cisplatin and other platinum-based agents, methotrexate, pemetrexed, ifosfamide, etc.) with well recognized nephrotoxicities (predominantly tubulointerstitial injury) remain in widespread use. Immunotherapies (e.g., immune checkpoint inhibitors and CAR-T therapies) may be associated with kidney immune-related adverse events, most often acute interstitial nephritis, and rarely, glomerular disease. Recently, multiple targeted cancer therapies have been associated with reduced renal tubular secretion of creatinine, causing elevations in serum creatinine and apparent 'pseudo-AKI'. To complicate matters further, these agents have had biopsy-proven, 'true' kidney injury attributed to them in numerous case reports.
Summary:
Clinicians in nephrology and oncology must be aware of the various potential kidney risks with these agents and recognize those with clinically meaningful impact on both cancer and kidney outcomes.
Insights
Cancer treatments, including chemotherapy, immunotherapy, and targeted therapy, pose risks for acute kidney injury (AKI). Awareness of these kidney risks is crucial for managing cancer and kidney outcomes.
Area of Science:
- Nephrology
- Oncology
- Pharmacology
Background:
- Cancer therapies are rapidly evolving, improving survival but introducing risks of acute kidney injury (AKI).
- Systemic cancer treatments encompass conventional chemotherapies, immunotherapies, and targeted therapies.
- These treatments can cause both true AKI and 'pseudo-AKI', complicating patient management.
Purpose of the Study:
- To review and summarize the literature on AKI associated with diverse systemic cancer treatments.
- To highlight the spectrum of kidney injuries, including AKI and pseudo-AKI, linked to cancer therapies.
- To inform clinicians about the renal risks posed by conventional, novel immunotherapies, and targeted cancer agents.
Main Methods:
- Literature review of existing studies on cancer therapies and associated kidney injury.
- Analysis of nephrotoxicities from conventional chemotherapies.
- Examination of kidney-related adverse events from immunotherapies and targeted therapies.
Main Results:
- Conventional chemotherapies (e.g., platinum-based agents) are associated with tubulointerstitial injury.
- Immunotherapies (e.g., immune checkpoint inhibitors, CAR-T) can cause acute interstitial nephritis and glomerular disease.
- Targeted therapies may lead to 'pseudo-AKI' by affecting creatinine secretion, alongside rare instances of biopsy-proven kidney injury.
Conclusions:
- Clinicians must recognize the potential kidney risks associated with various cancer treatments.
- Understanding these risks is vital for optimizing both cancer treatment efficacy and kidney health outcomes.
- Awareness of true AKI and pseudo-AKI is essential for appropriate patient management.
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