Renal late effects in patients treated for cancer in childhood: A report from the Children's Oncology Group

Abstract

Background Improvements in childhood cancer therapy have led to increasing numbers of long-term survivors. These survivors are at risk for a variety of late effects due to the disease itself, treatment exposures (surgery, chemotherapy, and radiotherapy), underlying medical problems, and health behaviors. The COG LTFU Guidelines are risk-based, exposure-related recommendations for the identification and management of late effects due to therapies utilized in the treatment of childhood cancer, and are designed for asymptomatic survivors presenting for routine medical follow-up two or more years after completion of cancer therapy. Procedure The COG Guidelines Task Force on Urinary Tract Complications conducted an extensive review of the medical literature via MEDLINE. Specific treatment exposures which were reviewed include nephrectomy, chemotherapy regimens known to be nephrotoxic (cisplatin, carboplatin, ifosfamide, and methotrexate) and renal irradiation. Literature sources were ranked according to the strength of evidence and are cited in the review. Conclusions This review summarizes the literature that supported the recommendations for cancer survivors at risk for nephrotoxicity previously outlined in the Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers (COG LTFU Guidelines).

Improvement in karyomegalic interstitial nephritis three years after ifosfamide and cisplatin therapy by corticosteroid

“…Cisplatin, high dose-methotrexate and ifosfamide are all notorious to cause nephrotoxicity. The review article for renal late effects on patients treated for cancer in childhood [4] revealed that ifosfamide may cause permanent and potentially progressive kidney damage. In contrast, it was also described that the outlook for long-term recovery or stability of renal function caused by cisplatin is generally favorable and that methotrexate-induced nephrotoxicity appears to be entirely reversible.…”

“…The most common manifestation of renal toxicity of ifosfamide is proximal tubular dysfunction and less often decreased GFR [4]. A statistically significant fall in mean GFR of 35 mL/min/1.73 m 2 was observed after completion of ifosfamide therapy [6].…”

Risk factors for chronic kidney disease after chemotherapy for testicular cancer

“…For urologists, the prevalence of CKD after radical nephrectomy is a current topic. 4 This study elucidated that CKD develops in testicular cancer survivors after chemotherapy at a relatively high rate. In addition, to assess renal function by the estimated glomerular filtration rate (eGFR), detection and management of factors causing progression of CKD, such as hypertension and proteinuria, are recommended for CKD patients and those with a high risk for CKD.…”

Nephrotoxicity of platinum derivatives in children – a review of the literature

“…Nephrotoxicity may present as an acute kidney injury, slowly progressing chronic renal disease or dysfunction of the renal tubules. These processes may or may not be reversible [2].…”