New drug toxicities in the onco-nephrology world

Abstract

New anticancer medications are rapidly entering the clinical arena offering patients with previously resistant cancers the promise of more effective therapies capable of extending their lives. However, adverse renal consequences develop in treated patients with underlying risk factors, requiring the nephrology community to be familiar with the nephrotoxic effects. The most common clinical nephrotoxic manifestations of these drugs include acute kidney injury, varying levels of proteinuria, hypertension, electrolyte disturbances, and at times chronic kidney disease. Thus, to practice competently in the 'onco-nephrology' arena, nephrologists will garner benefit from an update on older drugs with newly recognized nephrotoxic potential as well as newer agents, which may be associated with kidney injury. With that in mind, this brief update is meant to provide clinicians with the currently available evidence on the nephrotoxicity of a group of anticancer medications.

Relationship Between Mortality and Cancer‐Bearing Status in Patients With Chronic Kidney Disease Who Attended an Educational Program

“…Looking back on past reports, there are few reports about the association between malignancy and CKD. However, in recent years, the close relationship between malignancy and CKD is being increasingly recognized , and nephrologists are expected to play an active part in the care of these patients, firstly because certain renal disorders are unique to patients with cancer, related either to therapy or the malignancy itself, and there is an increasing need for nephrologists to provide input into their treatment. Nephrologists must provide expertise in the evaluation and management of acute and chronic kidney disease, fluid and electrolyte disorders, and the use of various extracorporeal therapies in patients with cancer.…”

Acute interstitial nephritis after sequential ipilumumab - nivolumab therapy of metastatic melanoma

“…[12, 13]. Immune interstitial nephritis has, however, been described in patients treated by nivolumab (0.3 mg/kg or 1 mg/kg) and ipilimumab (3 mg/kg) concomitantly [3, 10].…”

Spatial distribution of kidney disease in the contaminated site of Taranto (Italy)

“…We excluded the following case entities from our analysis: (a) cases with codes 580.81, 581.81, 582.81, 583.81, as the kidney disease is due to other disorders such as diabetes, lupus erythematosus, or infectious disease; (b) cases with previous or simultaneous diagnosis of cancer (codes 140‐208), ascertained also with the use of the “proxy” code “Encounter for antineoplastic chemotherapy and immunotherapy” (code V58.1), as neoplastic diseases and antineoplastic treatments can cause a variety of acute and chronic adverse renal effects; (c) cases who had undergone a non‐renal solid organ transplant (codes V42.1, V42.6, V42.7, V42.82‐V42.84), as kidney disease is a common complication of all forms of organ transplantation other than renal; and (d) cases with diagnosis of renal failure with previous/simultaneous diagnosis of diabetes (code 250), as diabetes is considered the leading cause of renal failure . The rationale of these exclusions was to focus on cases of kidney disease that were not due or associated with other well defined disease entities, among which diabetes was shown to be in excess in the Taranto area .…”