, Volume 17, Issue 2, pp 191-196

Acute and long-term nephrotoxicity of cis-platinum in man

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Summary

To detect whether the nephrotoxicity of cis-diaminodichloroplatinum (DDP) is acute and can be demonstrated at an early stage in man, a method for estimating the function of the kidneys during intensive hydration was devised. The method includes a calculation of the clearance of 125I-orthoiodohippurate and an estimation of the glomerular filtration rate (GFR) from fast changes of the extracellular volume (ECV) and the mean transit time of 99mTc-DTPA in this volume.

We examined nine patients with testicular cancer on 2 consecutive days for acute nephrotoxicity while they were undergoing treatment with cis-platinum. Placebo was given on day 1, cis-platinum on day 2. On both days the patients were hydrated with 4 l saline, glucose, and mannitol (0.5 l) over a period of 4 h, which resulted in an increase of 125I-orthoiodohippurate clearance on both days (P<0.01). The increase was, however, lower on the day of treatment with cis-platinum than on the day with placebo (P<0.05). There were no acute changes in the GFR. This indicates that treatment with DDP inhibits the active transport of 125I-orthoiodohippurate in the tubules; that is to say there is an acute effect on the kidney function.

There were no acute changes in the GFR, but in the long-term followup study we found that the GFR,had decreased significantly (P<0.05) after 2 months of treatment. During the first year after the initiation of treatment the GFR changes were found to progress. A significant increase in se-creatinine was not observed until 6 months after the initiation of treatment (P<0.05). The degree of chronic nephrotoxicity did not correlate in individual patients with the acute changes in kidney function.