Anticancer drug-related nephrotoxicity

Drug	Clinical renal syndrome	Renal histopathology	Prevention*
Cytotoxic drugs
Cyclophosphamide	Hyponatremia (SIADH) Hemorrhagic cystitis	None	Intravenous fluids Mesna
Gemcitabine	AKI Hematuria Hypertension Proteinuria	Thrombotic microangiopathy	Not available
Ifosfamide	AKI NDI Proximal tubulopathy (Fanconi syndrome)	Acute tubular injury	Dose adjustment Intravenous fluids
Methotrexate	AKI	Acute tubular injury Crystalline nephropathy	Intravenous fluids Urinary alkalinization
Mitomycin C	AKI Hematuria Hypertension Proteinuria	Thrombotic microangiopathy	Not available
Nitrosoureas	Chronic kidney disease	Chronic interstitial nephritis	Intravenous fluids
Pemetrexed	AKI NDI Proximal tubulopathy (Fanconi syndrome)	Acute tubular injury Interstitial fibrosis	Intravenous fluids
Platinum agents (cisplatin, carboplatin, oxaliplatin)	AKI Hypomagnesemia NDI Proximal tubulopathy (Fanconi syndrome) Salt wasting	Acute tubular injury	Dose adjustment Intravenous fluids Intravenous magnesium
Vinca alkaloids	Hyponatremia (SIADH)	None	Not available
Targeted agents
ALK inhibitors (crizotinib)	AKI Electrolyte disorders Renal microcysts	Acute interstitial nephritis Acute tubular injury	Not available
Anti-VEGF agents (aflibercept, bevacizumab)	AKI Hypertension Proteinuria	Thrombotic microangiopathy	Not available
BRAF inhibitors (dabrafenib, vemurafenib)	AKI Electrolyte disorders	Acute interstitial nephritis Acute tubular injury	Not available
EGFR inhibitors (cetuximab, erlotinib, gefitinib, panitumumab)	Hypomagnesemia	None	Not available
Imatinib	AKI Chronic kidney disease	Acute tubular injury	Not available
Rituximab	AKI (tumor lysis syndrome)	Acute tubular injury Crystalline (uric acid) nephropathy	Hypouricemic agents (allopurinol, rasburicase) Intravenous fluids
Tyrosine kinase inhibitors (axitinib, pazopanib, sorafenib, regorafenib, sunitinib)	AKI Hypertension Proteinuria	Acute interstitial nephritis Acute tubular injury Focal segmental glomerulosclerosis Thrombotic microangiopathy	Not available
Immunotherapy agents
Chimeric antigen receptor (CAR) T cells	Capillary leak syndrome with AKI Electrolyte disorders	None	Glucocorticoid prophylaxis Chemotherapy to reduce tumor burden
CTLA-4 inhibitors (ipilimumab, tremelimumab)	AKI Proteinuria	Acute interstitial nephritis Lupus-like glomerulonephritis Minimal change disease	Not available
Interferons (alpha, beta, gamma)	AKI Nephrotic-range proteinuria	Focal segmental glomerulosclerosis Thrombotic microangiopathy	Not available
Interleukin-2	AKI Capillary leak syndrome	None	Intravenous fluids
PD-1 inhibitors (nivolumab, pembrolizumab, cemiplimab)	AKI Proteinuria	Acute interstitial nephritis Acute tubular injury IgA nephropathy Minimal change disease Focal segmental glomerulosclerosis C3 glomerulopathy Membranous glomerulonephritis	Not available
PD-L1 inhibitors (atezolizumab, durvalumab, avelumab)	AKI	Acute interstitial nephritis	Not available
Other drugs
Deferasirox	AKI	Acute interstitial nephritis Acute tubular injury Fanconi syndrome	Not available
Pamidronate	AKI Nephrotic syndrome	Acute tubular injury Focal segmental glomerulosclerosis	Dose adjustment Increase infusion time
Sirolimus	AKI Proteinuria	Focal segmental glomerulosclerosis	Not available
Zoledronate	AKI Nephrotic syndrome	Acute tubular injury Focal segmental glomerulosclerosis (rare)	Dose adjustment

SIADH: syndrome of inappropriate antidiuretic hormone; AKI: acute kidney injury; NDI: nephrogenic diabetes insipidus; ALK: anaplastic lymphoma kinase; VEGF: vascular endothelial growth factor; EGFR: epidermal growth factor receptor; CTLA-4: cytotoxic T-lymphocyte-associated protein 4; PD-1: programmed cell death-1; PD-L1: programmed cell death-1 ligand-1.
* In addition to minimizing exposure to other nephrotoxins.

Graphic 112219 Version 2.0

خرید پکیج

Anticancer drug-related nephrotoxicity