Renoprotective approaches against anthracycline nephrotoxicity

Nephrotoxicity is a significant adverse effect of many cancer chemotherapies, often limiting treatment success and complicating clinical management. The kidneys are essential for removing antineoplastic drugs and their metabolites through glomerular filtration and tubular secretion. Unfortunately, both traditional cytotoxic agents and newer targeted therapies can harm various parts of the nephron, including the renal vasculature. This damage can present clinically as proteinuria, hypertension, electrolyte imbalances, glomerulopathies, acute and chronic interstitial nephritis, acute kidney injury (AKI), and often progression to chronic kidney disease (CKD). Among cytotoxic drugs, anthracyclines, potent natural antibiotics, are widely used to treat a broad range of cancers. Doxorubicin (DOX), the most common anthracycline, is particularly effective but also linked to notable nephrotoxic effects. Doxorubicin-induced kidney damage is multifactorial, involving oxidative stress, inflammation, and apoptosis, which collectively impair renal structure and function. This review discusses the mechanisms behind doxorubicin-induced nephrotoxicity and emphasizes the urgent need for nephroprotective strategies. It also reviews current therapies under investigation to reduce renal damage caused by DOX, including natural compounds and pharmacological agents that target oxidative and inflammatory pathways, aiming to preserve renal function and improve the safety of chemotherapy treatments.