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Kidney damage and chemotherapy

Some chemotherapy drugs can damage the kidneys (nephrotoxicity). The kidneys break down and remove many chemotherapy drugs from the body. When chemotherapy drugs break down, they make products that can damage cells in the kidneys, ureters and bladder. The potential for kidney damage varies with the type of chemotherapy drug used.

Causes

Chemotherapy drugs that can cause kidney damage include:

  • cisplatin (Platinol AQ)
  • carboplatin (Paraplatin)
  • nitrosureas, such as carmustine (BiCNU, BCNU)
  • mitomycin (Mutamycin)
  • methotrexate – especially if high doses are used

 

Whether or not a chemotherapy drug will cause kidney damage depends on:

  • the dose of the drug used
  • if other drugs, which also have the potential to damage the kidney, are used at the same time
  • if the person already has kidney disease

Symptoms

Some symptoms that may suggest kidney damage and impaired kidney (renal) function include:

  • headache
  • fatigue
  • weakness
  • nausea
  • vomiting
  • increased blood pressure
  • less urination
  • edema (swelling or puffiness) of the hands, feet or other areas of the body

 

Symptoms can occur during chemotherapy treatment and may be temporary. Kidney function can be affected for several years and may be permanent. Damage may be mild to severe. If severe, it can lead to kidney failure.

Diagnosis

Before chemotherapy starts, kidney function may be checked to make sure there are no major problems. This can also be done during treatments to ensure that nothing has changed. Blood tests are usually done to check kidney function and to check fluid and electrolyte balance.

Prevention and management

The healthcare team takes measures to help prevent and manage kidney problems that may occur because of chemotherapy. Some of these measures include:

  • Extra fluids may be given intravenously (into a vein) to help flush the products produced when chemotherapy drugs break down from the kidneys.
  • Fluid and electrolyte levels in blood or urine samples are checked during treatment.
    • These levels tell the healthcare team how well the kidneys are working.
    • They also help the healthcare team detect kidney damage early, especially in people with existing kidney disease.
  • A drug called amifostine (Ethyol) may be given to protect the kidneys when high doses of cisplatin are given.
  • The dose of the drug may be lowered or the drug may be stopped completely if kidney damage occurs.
  • Dialysis may be done to clean waste products from the blood if severe kidney damage occurs and causes the kidneys to fail.
    • Dialysis can be done using a special solution and tissues within the abdomen (peritoneal dialysis) or with an artificial kidney machine (hemodialysis).

 

Tell the doctor or healthcare team about any swelling or puffiness that happens suddenly. Let them know about any changes in urination.

 

You can help prevent kidney problems and cope with symptoms by taking the following steps:

  • Drink plenty of fluids to ensure a regular flow of urine.
  • Eat less salt and salty foods (such as chips, prepared foods, luncheon meats or pickles). Replace salt with herb seasonings or pepper.
  • Raise legs if feet are swollen.
  • Avoid wearing tight or constrictive clothing.

 

For more detailed information on specific drugs, go to sources of drug information.

References

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