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Renal tubular damage without glomerular damage after cytotoxic drugs and aminoglycosides

J J Fleming, J A Child, E H Cooper

    Biomedicine / [Publiee Pour L'A.A.I.C.I.G.]
    |December 1, 1980
    PubMed

    Insights

    Cytotoxic drugs and aminoglycosides can cause kidney damage, indicated by elevated urinary biomarkers. Methotrexate showed the most significant effects, while aminoglycosides also caused protein in urine, especially in vulnerable patients.

    Area of Science:

    • Nephrology
    • Oncology
    • Pharmacology

    Background:

    • Cytotoxic agents and aminoglycosides are commonly used in cancer therapy and for treating infections.
    • Renal toxicity is a known side effect of these drug classes.
    • Early detection of kidney damage is crucial for patient management.

    Purpose of the Study:

    • To evaluate the impact of cytotoxic agents and aminoglycosides on renal tubular function.
    • To identify specific drugs causing the most significant tubular damage.
    • To assess the risk factors for drug-induced kidney injury in vulnerable patient populations.

    Main Methods:

    • Monitoring urinary biomarkers: beta 2-microglobulin (beta 2-m), N-acetyl-beta-D-glucosaminidase (NAG), and total protein.
    • Assessing renal function in patients receiving cytotoxic drugs and/or aminoglycosides for up to eleven days.
    • Comparing the degree of tubular damage across different drug regimens and patient groups.

    Main Results:

    • Both cytotoxic agents and aminoglycosides led to increased urinary beta 2-m, NAG, and total protein, indicating renal tubular damage.
    • Methotrexate (MTX) induced the most pronounced tubular changes among the cytotoxic agents studied.
    • Aminoglycosides, even at prophylactic doses, caused tubuloproteinuria, with the most severe damage observed in patients with hematological malignancies receiving them for sepsis post-chemotherapy.
    • No evidence of glomerular damage or increased glomerular permeability was found seven days after chemotherapy initiation.

    Conclusions:

    • Short-term administration of cytotoxic agents and aminoglycosides can cause significant renal tubular injury.
    • Methotrexate and aminoglycosides are key agents associated with this toxicity.
    • Vulnerable patient groups, such as those with hematological malignancies undergoing chemotherapy and treated for sepsis, are at higher risk for aminoglycoside-induced nephrotoxicity.

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