Nephrotoxicity in cancer treatment: An overview

Abstract

Anticancer drug nephrotoxicity is an important and increasing adverse drug event that limits the efficacy of cancer treatment. The kidney is an important elimination pathway for many antineoplastic drugs and their metabolites, which occurs by glomerular filtration and tubular secretion. Chemotherapeutic agents, both conventional cytotoxic agents and molecularly targeted agents, can affect any segment of the nephron including its microvasculature, leading to many clinical manifestations such as proteinuria, hypertension, electrolyte disturbances, glomerulopathy, acute and chronic interstitial nephritis, acute kidney injury and at times chronic kidney disease. The clinician should be alert to recognize several factors that may maximize renal dysfunction and contribute to the increased incidence of nephrotoxicity associated with these drugs, such as intravascular volume depletion, the associated use of nonchemotherapeutic nephrotoxic drugs (analgesics, antibiotics, proton pump inhibitors, and bone-targeted therapies), radiographic ionic contrast media or radiation therapy, urinary tract obstruction, and intrinsic renal disease. Identification of patients at higher risk for nephrotoxicity may allow the prevention or at least reduction in the development and severity of this adverse effect. Therefore, the aim of this brief review is to provide currently available evidences on oncologic drug-related nephrotoxicity.

Keywords: Acute kidney injury, Cancer, Chemotherapy, Conventional cytotoxic agents, Molecularly targeted agents, Nephrotoxicity

Core tip: Nephrotoxicity is an adverse event that is well described with the use of conventional cytotoxic agents and with the advent of new agents directed to specific genes/proteins in recent decades. Its nephrotoxic potential has also been observed, which limits the effectiveness of treatment and increases the morbidity and mortality of these patients. Our objective was to recognize the main chemotherapeutic drugs with nephrotoxic potential and the most common types of kidney injury to prevent or at least reduce their occurrence and severity, allowing better therapeutic indices.