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International Journal of Clinical Oncology
Published in: International Journal of Clinical Oncology 10/2023

16-07-2023 | Kidney Injury | Special Article

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

Authors: Yuichi Ando, Hiroyuki Nishiyama, Hideki Shimodaira, Nao Takano, Emiko Sakaida, Koji Matsumoto, Koki Nakanishi, Hideki Sakai, Shokichi Tsukamoto, Keigo Komine, Yoshinari Yasuda, Taigo Kato, Yutaka Fujiwara, Takafumi Koyama, Hiroshi Kitamura, Takashige Kuwabara, Atsushi Yonezawa, Yuta Okumura, Kimikazu Yakushijin, Kazuki Nozawa, Hideaki Goto, Takeshi Matsubara, Junichi Hoshino, Motoko Yanagita, the Committee of Clinical Practice Guidelines for the Management of Kidney Disease During Anticancer Drug Therapy 2022

Published in: International Journal of Clinical Oncology | Issue 10/2023

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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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Metadata
Title
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
Authors
Yuichi Ando
Hiroyuki Nishiyama
Hideki Shimodaira
Nao Takano
Emiko Sakaida
Koji Matsumoto
Koki Nakanishi
Hideki Sakai
Shokichi Tsukamoto
Keigo Komine
Yoshinari Yasuda
Taigo Kato
Yutaka Fujiwara
Takafumi Koyama
Hiroshi Kitamura
Takashige Kuwabara
Atsushi Yonezawa
Yuta Okumura
Kimikazu Yakushijin
Kazuki Nozawa
Hideaki Goto
Takeshi Matsubara
Junichi Hoshino
Motoko Yanagita
the Committee of Clinical Practice Guidelines for the Management of Kidney Disease During Anticancer Drug Therapy 2022
Publication date
16-07-2023
Publisher
Springer Nature Singapore
Published in
International Journal of Clinical Oncology / Issue 10/2023
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI
https://doi.org/10.1007/s10147-023-02382-2

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