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Nephrotoxicity of Chemotherapy Agents

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Onconephrology

Abstract

Chemotherapy agents are indispensable in the treatment of malignant diseases. However, they have adverse drug effects including nephrotoxicity that can contribute significantly to morbidity and mortality in patients with cancer. The potential for nephrotoxicity depends on a particular drug’s mechanism of action, the kidney microenvironment, and patient characteristics such as presence of other comorbidities, hemodynamic status, age, and less likely, gender of the patient. Intrinsic renal injury is the most common type of nephrotoxicity, and some agents can cause site-specific injury in the nephron, affecting the tubules, vasculature, glomeruli, the interstitium, or a combination of these sites. A classic example of site specificity is the proclivity of anti-vascular endothelial growth factor (VEGF) agents to cause glomerular endothelial damage. Thus, these result in distinct clinical syndromes such as: (1) acute tubular necrosis, (2) tubulopathies, (3) crystal nephropathy, (4) vascular injury (thromobotic microangiopathy), and (5) glomerular disease. Management of chemotherapy-induced nephrotoxicity includes preventive and treatment measures. Preserving kidney function is of paramount importance for allowing patients to continue chemotherapy safely and effectively. Thus, strategies for prevention, early detection, and proper management of nephrotoxicity associated with chemotherapy agents will be reviewed in this chapter

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Abbreviations

ADH:

Antidiuretic hormone

ADT:

Androgen deprivation therapy

AIN:

Acute interstitial nephritis

AKI:

Acute kidney injury

ALK:

Anaplastic lymphoma kinase

ATN:

Acute tubular necrosis

CKD:

Chronic kidney disease

CNS:

Central nervous system

DI:

Diabetes insipidus

DHFR:

Dihydrofolate reductase

EGF:

Epidermal growth factor

FS:

Fanconi syndrome

FSGS:

Focal segmental glomerulosclerosis

GFR:

Glomerular filtration rate

HTN:

Hypertension

INF:

Interferon

MCD:

Minimal change disease

MHC:

Major histocompatibility complex

MPGN:

Membranoproliferative glomerulonephritis

mTOR:

Mammalian target of rapamycin

MTX:

Methotrexate

NS:

Nephrotic syndrome

OCT:

Organic cationic transporters

RNR:

Ribonucleotide reductase

RSWS:

Renal salt wasting syndrome

RTA:

Renal tubular acidosis

RTEC:

Renal tubular epithelial cells

SIADH:

Syndrome of inappropriate antidiuretic hormone

TMA:

Thrombotic microangiopathy

TNF:

Tumor necrosis factor

TRPM:

Transient receptor potential melastin

VEGF:

Vascular endothelial growth factor

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Authors and Affiliations

  1. Section of Nephrology, Yale University School of Medicine, P.O. Box 208029, 06520-8029, New Haven, CT, USA

    Aziz K. Valika (Clinical Instructor) & Anushree Shirali

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  1. Aziz K. Valika
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  2. Anushree Shirali
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Correspondence to Anushree Shirali .

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Editors and Affiliations

  1. Department of Medicine, Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore LIJ School of Medicine, Great Neck, New York, USA

    Kenar D. Jhaveri

  2. Nephrology Section, General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Abdulla K. Salahudeen

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Valika, A., Shirali, A. (2015). Nephrotoxicity of Chemotherapy Agents. In: Jhaveri, K., Salahudeen, A. (eds) Onconephrology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2659-6_4

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