Side Effect: Kidney Injury (Renal Dysfunction)

Renal dysfunction refers to a decrease in kidney function, which can be caused by various factors such as medications, dehydration, infections, or diseases like cancer.
Kidney injury is a term used to describe damage to the kidney tissues that may be caused by similar factors.

The symptoms of kidney injury can vary depending on the severity and the underlying cause. Some common symptoms include:

• decreased urine output
• swelling in the legs or feet
• fatigue
• nausea
• shortness of breath

The kidneys play an important role in the body. They help to rid the body if certain medications as well as specific drugs that are used to treat cancer by causing these molecules to be excreted in the urine.

Sometimes drugs have off-target effects, and can harm the cells in your kidneys, or the ureters (the tubes that connect your kidneys to your bladder), or bladder.
When a treatment is harmful to the kidneys, it is referred to as being “nephrotoxic.” Whether or not a drug will cause kidney damage depends upon the type of drug, the dose of the drug, other medications being taken, and existing kidney health.

Patients with cancer may also have tumor-related complications or kidney injury due to radiation therapy.

Chemotherapy drugs that are known to be nephrotoxic include:

• cisplatin
• carboplatin
• ifosfamide (Ifex®)
• methotrexate

• Staying well-hydrated before and during cancer treatment can help protect the kidneys from damage.
• Oral hydration (drinking fluids) is helpful, but your physician may also order intravenous (IV) fluids to help maintain kidney function and flush out toxins.
• Some medications can protect the kidneys during cancer treatment, and these may be administered before specific therapies.
• Depending on your kidney health, your doctor may lower the dose of the chemotherapy drug or even stop it completely if they notice any kidney damage.
• It is important to catch any signs of kidney injury early (for example, if you are unable to urinate) so your healthcare team can assess this issue and try to reverse the cause as soon as possible.

• The treatment of kidney injury in patients with cancer depends upon the underlying cause and the severity of the injury. Supportive measures such as fluid resuscitation, electrolyte replacement, and discontinuation of nephrotoxic medications are important in the management of kidney injury.
• You might be prescribed a diuretic to increase the amount of water you excrete in the urine. A commonly used diuretic is furosemide (Lasix®). Lasix should be used with extreme caution in patients receiving methotrexate as it can lead to build up and toxicity of this chemotherapy agent.
• In severe cases dialysis (the use of a machine to remove excess waste and fluid) may be necessary.