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Chapter 3: Management of kidney injury caused by cancer drug therapy, from clinical practice guidelines for the management of kidney injury during anticancer drug therapy 2022

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Abstract

Cisplatin should be administered with diuretics and Magnesium supplementation under adequate hydration to avoid renal impairment. Patients should be evaluated for eGFR (estimated glomerular filtration rate) during the treatment with pemetrexed, as kidney injury has been reported. Pemetrexed should be administered with caution in patients with a CCr (creatinine clearance) < 45 mL/min. Mesna is used to prevent hemorrhagic cystitis in patients receiving ifosfamide. Febuxostat is effective in avoiding hyperuricemia induced by TLS (tumor lysis syndrome). Preventative rasburicase is recommended in high-risk cases of TLS. Thrombotic microangiopathy could be triggered by anticancer drugs and there is no evidence of efficacy of plasma exchange therapy. When proteinuria occurs during treatment with anti-angiogenic agents or multi-kinase inhibitors, dose reductions or interruptions based on grading should be considered. Grade 3 proteinuria and renal dysfunction require urgent intervention, including drug interruption or withdrawal, and referral to a nephrologist should be considered. The first-line drugs used for blood pressure elevation due to anti-angiogenic agents are ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers). The protein binding of drugs and their pharmacokinetics are considerably altered in patients with hypoalbuminemia. The clearance of rituximab is increased in patients with proteinuria, and the correlation with urinary IgG suggests similar pharmacokinetic changes when using other antibody drugs. AIN (acute interstitial nephritis) is the most common cause of ICI (immune checkpoint inhibitor)-related kidney injury that is often treated with steroids. The need for renal biopsy in patients with kidney injury that occurs during treatment with ICI remains controversial.

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Acknowledgements

This article is the secondary publication from the Japanese version by the Japanese Society of Nephrology (JSN), Japan Society of Clinical Oncology (JSCO), Japanese Society of Medical Oncology (JSMO), and The Japanese Society of Nephrology and Pharmacotherapy (JSNP) that was published Lifescience publishers Co Ltd, Tokyo, Japan, with permission. We greatly thank other guideline committee members for peer reviews and external review teams from JSN, JSCO, JSMO, JSNP, and the Japanese Society for Dialysis Therapy for their suggestive advice and cooperation. We also thank Toshio Morizane (Japan Council for Quality Health Care), Takeo Nakayama (Department of Health Informatics, School of Public Health, Kyoto University Graduate School of Medicine), and Shigeo Horie (Department of Urology, Juntendo University Faculty of Medicine) for an advisor, Naoki Kashihara (Kawasaki Medical School), Mototsugu Oya (Keio University School of Medicine), Hirokazu Okada (Saitama Medical University), and Masaomi Nangaku (The University of Tokyo) for supervisors of the guideline, Takashi Yokoo (JSN academic committee chairman, Jikei University School of Medicine) and Kengo Furuichi (JSN academic committee vice chairman, Kanazawa Medical University School of Medicine) for observers, Eiichiro Kanda (Kawasaki Medical School) and Takaaki Suzuki (Nara Medical University Library) for systematic literature searching, Hitoshi Watanabe (Lifescience, Co. Ltd.) for editing the Japanese version of the guidelines, office staffs of JSN, JSCO, JSMO, and JSNP, and Yasuhiro Komatsu (Gunma University) for helpful supports.

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Y.A has received honoraria from Chugai Pharmaceutical Co., Ltd., Bayer Holding Ltd., and research funding from Chugai Pharmaceutical Co., Ltd., Geo Holdings Corporation, and BeiGene, Ltd. H.N has received honoraria from MSD K.K., Astellas pharma Inc., and Merck Biopharma Co., Ltd., research fundings from Chugai Pharmaceutical Co. Ltd., and a scholarship donation from Bayer AG. E.S has received honoraria from Pfizer Japan Inc., Bristol-Myers Squibb Company, Takeda Pharmaceutical Company Limited, Novartis Pharmaceuticals Corporation, and Janssen Pharmaceutical K.K. K.M has received honoraria from MSD, Kyowa Kirin Co., Ltd., and Chugai-Pharmaceutical Co., Ltd., and research fundings from DAIICHI SANKYO COMPANY, MSD, Eli Lilly Japan K.K, Gilead Sciences, and Eisai Co., Ltd. Y.F has received honoraria from AstraZeneca, Bristol-Myers Squibb Company, Chugai-Pharmaceutical Co., Ltd., DAIICHI SANKYO COMPANY, Micron, MSD, and ONO PHARMACEUTICAL CO., LTD., and research fundings from Abbvie, Amgen, AnHeart, AstraZeneca, Bristol-Myers Squibb Company, Chugai-Pharmaceutical Co., Ltd., Eli Lilly Japan K.K, Incyte, and MSD. T.K has received honoraria from Chugai, AstraZeneca and Sysmex, and research funding from PACT Pharma, Chugai, Daiichi-Sankyo, Novartis, Eli Lilly, Pfizer, Janssen Pharmaceutical K.K., Zymworks, and Takeda Pharmaceutical Company Limited. H.K has received honoraria from Astellas Pharma Inc, Takeda Pharmaceutical Company Limited, Bayer AG, and Janssen Pharmaceutical K.K., and scholarship donations from Takeda Pharmaceutical Company Limited and Bayer AG. T. K received honoraria from AstraZeneca. J.H has received honoraria from Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma, Ono Pharm, AstraZeneca and Astellas Pharma Inc, and a research grant from Otsuka Pharmaceutical Co., Ltd. M. Yanagita has received honoraria from Astellas Pharma Inc, AstraZeneca, Kyowa Kirin Co., Ltd., Chugai-Pharmaceutical Co., Ltd., Bayer AG, and Mitsubishi Tanabe Pharma, and research grants from Mitsubishi Tanabe Pharma, Boehringer Ingelheim International GmbH, and scholarship donations from Kyowa Kirin Co., Ltd., Chugai-Pharmaceutical Co., Ltd., and Mitsubishi Tanabe Pharma. The other authors declare no potential conflicts of interest.

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Ando, Y., Nishiyama, H., Shimodaira, H. et al. Chapter 3: Management of kidney injury caused by cancer drug therapy, from clinical practice guidelines for the management of kidney injury during anticancer drug therapy 2022. Int J Clin Oncol 28, 1315–1332 (2023). https://doi.org/10.1007/s10147-023-02382-2

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