Abstract
The sub-field of onco-nephrology has rapidly grown with the proliferation of highly effective cancer therapies and the remarkable improvement in patient survival. Conventional cytotoxic chemotherapy is a backbone of cancer therapy, often employed alone or with targeted agents and immunotherapies. However, beneficial anti-cancer effects are often complicated by nephrotoxicity, which includes acute and chronic kidney injury. While numerous conventional cytotoxic chemotherapy drugs are nephrotoxic, some of the most common offenders that clinicians encounter are cisplatin, ifosfamide, methotrexate, pemetrexed, gemcitabine, melphalan, and mitomycin C. They will be the focus of this review.
This ADQI Consensus Conference Workgroup covered cytotoxic chemotherapy nephrotoxicity and reviewed several aspects of their adverse renal complications. Included are 1) epidemiology of each agent’s nephrotoxicity, 2) mechanisms of nephrotoxicity, 3) predisposing risk factors, 4) clinical manifestations of nephrotoxicity, 5) prevention and management of kidney injury, and 6) research agenda addressing knowledge gaps for the noted nephrotoxic cytotoxic chemotherapy.