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Quiroz-Aldave JE, Durand-Vásquez MDC, Chávez-Vásquez FS, Rodríguez-Angulo AN, Gonzáles-Saldaña SE, Alcalde-Loyola CC, Coronado-Arroyo JC, Zavaleta-Gutiérrez FE, Concepción-Urteaga LA, Haro-Varas JC, Concepción-Zavaleta MJ. Ifosfamide-induced nephrotoxicity in oncological patients. Expert Rev Anticancer Ther 2024; 24:5-14. [PMID: 38031874 DOI: 10.1080/14737140.2023.2290196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Ifosfamide is an alkylating chemotherapeutic agent used in the treatment of various neoplasms. Its main adverse effects include renal damage. AREAS COVERED A comprehensive review was conducted, including 100 articles from the Scielo, Scopus, and EMBASE databases. Ifosfamide-induced nephrotoxicity is attributed to its toxic metabolites, such as acrolein and chloroacetaldehyde, which cause mitochondrial damage and oxidative stress in renal tubular cells. Literature review found a 29-year average age with no gender predominance and a mortality of 13%. Currently, no fully effective strategy exists for preventing ifosfamide-induced nephrotoxicity; however, hydration, forced diuresis, and other interventions are employed to limit renal damage. Long-term renal function monitoring is essential for patients treated with ifosfamide. EXPERT OPINION Ifosfamide remains essential in neoplasm treatment, but nephrotoxicity, often compounded by coadministered drugs, poses diagnostic challenges. Preventive strategies are lacking, necessitating further research. Identifying timely risk factors can mitigate renal damage, and a multidisciplinary approach manages established nephrotoxicity. Emerging therapies may reduce ifosfamide induced nephrotoxicity.
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Affiliation(s)
- Juan Eduardo Quiroz-Aldave
- Division of Non-communicable diseases, Endocrinology research line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | | | | | | | | | | | | | | | - Juan Carlos Haro-Varas
- Division of Medical Oncology, Division of Medical Oncology. Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
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2
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Chui H, McMahon KR, Rassekh SR, Schultz KR, Blydt-Hansen TD, Mammen C, Pinsk M, Cuvelier GDE, Carleton BC, Tsuyuki RT, Ross CJD, Devarajan P, Huynh L, Yordanova M, Crépeau-Hubert F, Wang S, Cockovski V, Palijan A, Zappitelli M. Urinary TIMP-2*IGFBP-7 to diagnose acute kidney injury in children receiving cisplatin. Pediatr Nephrol 2024; 39:269-282. [PMID: 37365422 DOI: 10.1007/s00467-023-06007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Cisplatin is associated with acute kidney injury (AKI) and electrolyte abnormalities. Urine tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP-7) may be early cisplatin-AKI biomarkers. METHODS We conducted a 12-site prospective cohort study with pediatric patients treated with cisplatin (May 2013-December 2017). Blood and urine (measured for TIMP-2, IGFBP-7) were collected pre-cisplatin, 24-h post-cisplatin, and near hospital discharge during the first or second cisplatin cycle (early visit (EV)) and during second-to-last or last cisplatin cycle (late visit (LV)). PRIMARY OUTCOME serum creatinine (SCr)-defined AKI (≥ stage 1). RESULTS At EV (median (interquartile (IQR)) age: 6 (2-12) years; 78 (50%) female), 46/156 (29%) developed AKI; at LV, 22/127 (17%) experienced AKI. At EV, TIMP-2, IGFBP-7, and TIMP-2*IGFBP-7 pre-cisplatin infusion concentrations were significantly higher in participants with vs. those without AKI. At EV and LV, biomarker concentrations were significantly lower in participants with vs. those without AKI at post-infusion and near-hospital discharge. Biomarker values normalized to urine creatinine were higher in patients with AKI compared to without (LV post-infusion, median (IQR): TIMP-2*IGFBP-7: 0.28 (0.08-0.56) vs. 0.04 (0.02-0.12) (ng/mg creatinine)2/1000; P < .001). At EV, pre-infusion biomarker concentrations had the highest area under the curves (AUC) (range: 0.61-0.62) for AKI diagnosis; at LV, biomarkers measured post-infusion and near discharge yielded the highest AUCs (range: 0.64-0.70). CONCLUSIONS TIMP-2*IGFBP-7 were poor to modest at detecting AKI post-cisplatin. Additional studies are needed to determine whether raw biomarker values or biomarker values normalized to urinary creatinine are more strongly associated with patient outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Hayton Chui
- Department of Pediatrics, Division of Nephrology, Peter Gilgan Centre For Research and Learning, Child Health Evaluative Sciences, Toronto Hospital for Sick Children, University of Toronto, Room 11th Floor, 11.9722, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Kelly R McMahon
- Department of Pediatrics, Division of Nephrology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Shahrad Rod Rassekh
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Kirk R Schultz
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, Division of Pediatric Nephrology, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Cherry Mammen
- Department of Pediatrics, Division of Pediatric Nephrology, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Maury Pinsk
- Department of Pediatrics and Child Health, Section of Pediatric Nephrology, University of Manitoba, Winnipeg, MB, Canada
| | - Geoffrey D E Cuvelier
- Department of Pediatrics and Child Health, Division of Pediatric Oncology-Hematology-BMT, University of Manitoba, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia and BC Children's Hospital and Research Institute, Vancouver, BC, Canada
| | - Ross T Tsuyuki
- Epidemiology Coordinating and Research (EPICORE) Centre, Departments of Medicine and Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Colin J D Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Louis Huynh
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Mariya Yordanova
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédérik Crépeau-Hubert
- Department of Pediatrics, Division of Nephrology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Stella Wang
- Department of Pediatrics, Division of Nephrology, Peter Gilgan Centre For Research and Learning, Child Health Evaluative Sciences, Toronto Hospital for Sick Children, University of Toronto, Room 11th Floor, 11.9722, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Vedran Cockovski
- Department of Pediatrics, Division of Nephrology, Peter Gilgan Centre For Research and Learning, Child Health Evaluative Sciences, Toronto Hospital for Sick Children, University of Toronto, Room 11th Floor, 11.9722, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Ana Palijan
- Department of Pediatrics, Division of Nephrology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, Peter Gilgan Centre For Research and Learning, Child Health Evaluative Sciences, Toronto Hospital for Sick Children, University of Toronto, Room 11th Floor, 11.9722, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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3
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Michel C, Simon E. [Angiotensin-converting enzyme inhibitor and fetal nephromegaly]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:497-498. [PMID: 35081451 DOI: 10.1016/j.gofs.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Affiliation(s)
- C Michel
- Service de gynécologie obstétrique, médecine fœtale et stérilité conjugale, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - E Simon
- Service de gynécologie obstétrique, médecine fœtale et stérilité conjugale, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Université Bourgogne Franche-Comté, Dijon, France
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4
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Jain A, Huang R, Lee J, Jawa N, Lim YJ, Guron M, Abish S, Boutros PC, Brudno M, Carleton B, Cuvelier GDE, Gunaratnam L, Ho C, Adeli K, Kuruvilla S, Lajoie G, Liu G, Nathan PC, Rod Rassekh S, Rieder M, Waikar SS, Welch SA, Weir MA, Winquist E, Wishart DS, Zorzi AP, Blydt-Hansen T, Zappitelli M, Urquhart B. A Canadian Study of Cisplatin Metabolomics and Nephrotoxicity (ACCENT): A Clinical Research Protocol. Can J Kidney Health Dis 2021; 8:20543581211057708. [PMID: 34820133 PMCID: PMC8606978 DOI: 10.1177/20543581211057708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Cisplatin, a chemotherapy used to treat solid tumors, causes acute kidney injury (AKI), a known risk factor for chronic kidney disease and mortality. AKI diagnosis relies on biomarkers which are only measurable after kidney damage has occurred and functional impairment is apparent; this prevents timely AKI diagnosis and treatment. Metabolomics seeks to identify metabolite patterns involved in cell tissue metabolism related to disease or patient factors. The A Canadian study of Cisplatin mEtabolomics and NephroToxicity (ACCENT) team was established to harness the power of metabolomics to identify novel biomarkers that predict risk and discriminate for presence of cisplatin nephrotoxicity, so that early intervention strategies to mitigate onset and severity of AKI can be implemented. Objective: Describe the design and methods of the ACCENT study which aims to identify and validate metabolomic profiles in urine and serum associated with risk for cisplatin-mediated nephrotoxicity in children and adults. Design: Observational prospective cohort study. Setting: Six Canadian oncology centers (3 pediatric, 1 adult and 2 both). Patients: Three hundred adults and 300 children planned to receive cisplatin therapy. Measurements: During two cisplatin infusion cycles, serum and urine will be measured for creatinine and electrolytes to ascertain AKI. Many patient and disease variables will be collected prospectively at baseline and throughout therapy. Metabolomic analyses of serum and urine will be done using mass spectrometry. An untargeted metabolomics approach will be used to analyze serum and urine samples before and after cisplatin infusions to identify candidate biomarkers of cisplatin AKI. Candidate metabolites will be validated using an independent cohort. Methods: Patients will be recruited before their first cycle of cisplatin. Blood and urine will be collected at specified time points before and after cisplatin during the first infusion and an infusion later during cancer treatment. The primary outcome is AKI, defined using a traditional serum creatinine-based definition and an electrolyte abnormality-based definition. Chart review 3 months after cisplatin therapy end will be conducted to document kidney health and survival. Limitations: It may not be possible to adjust for all measured and unmeasured confounders when evaluating prediction of AKI using metabolite profiles. Collection of data across multiple sites will be a challenge. Conclusions: ACCENT is the largest study of children and adults treated with cisplatin and aims to reimagine the current model for AKI diagnoses using metabolomics. The identification of biomarkers predicting and detecting AKI in children and adults treated with cisplatin can greatly inform future clinical investigations and practices.
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Affiliation(s)
- Anshika Jain
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Ryan Huang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jasmine Lee
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Jawa
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yong Jin Lim
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mike Guron
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Sharon Abish
- Division of Hematology and Oncology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Paul C Boutros
- Computational Biology Program, Ontario Institute for Cancer Research, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, ON, Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, ON, Canada.,Canada Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bruce Carleton
- Department of Pediatrics, The University of British Columbia, Vancouver, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | | | - Lakshman Gunaratnam
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cheryl Ho
- Medical Oncology, BC Cancer, The University of British Columbia, Vancouver, Canada
| | - Khosrow Adeli
- Molecular Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,University of Toronto, ON, Canada, Canada
| | - Sara Kuruvilla
- Division of Medical Oncology, Department of Oncology, Western University, London, ON, Canada
| | - Giles Lajoie
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shahrad Rod Rassekh
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Michael Rieder
- Department of Pediatrics, Western University, London, ON, Canada
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine, MA, USA.,Boston Medical Center, MA, USA
| | - Stephen A Welch
- Division of Medical Oncology, Department of Oncology, Western University, London, ON, Canada
| | - Matthew A Weir
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Eric Winquist
- Division of Medical Oncology, Department of Oncology, Western University, London, ON, Canada
| | - David S Wishart
- Department of Biochemistry, University of Alberta, Edmonton, Canada
| | - Alexandra P Zorzi
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital, Western University, London, ON, Canada
| | - Tom Blydt-Hansen
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Michael Zappitelli
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bradley Urquhart
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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5
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Lebel A, Chui H, McMahon KR, Lim YJ, Macri J, Wang S, Devarajan P, Blydt-Hansen TD, Zappitelli M, Urquhart BL. Association of Urine Platinum With Acute Kidney Injury in Children Treated With Cisplatin for Cancer. J Clin Pharmacol 2021; 61:871-880. [PMID: 33599997 PMCID: PMC8283690 DOI: 10.1002/jcph.1839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/15/2021] [Indexed: 01/19/2023]
Abstract
Cisplatin is a chemotherapeutic agent highly excreted in urine and known to cause acute kidney injury (AKI). As AKI diagnosis by serum creatinine (SCr) is usually delayed, endeavors for finding early AKI biomarkers continue. This study aims to determine if urine platinum (UP) concentration 24 hours after cisplatin infusion is associated with AKI, and to evaluate the association between urine platinum and tubular damage biomarkers: neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). Children treated with cisplatin in 12 Canadian centers (April 2013 to December 2017) were included. Urine from the morning after the first cisplatin infusion of the first or second cisplatin cycle was measured for urine platinum, NGAL, and KIM-1. SCr and serum electrolytes were used to detect AKI by either SCr elevation or urinary electrolyte wasting (potassium, magnesium, phosphate). The associations of urine platinum with AKI, NGAL, and KIM-1 were assessed. A total of 115 participants (54% boys, median age, 8.5 years; interquartile range, 4.0-13.4) were included, of which 29 (25%) and 105 (91%) developed AKI defined by SCr and electrolyte criteria, respectively. Higher urine platinum was associated with higher cisplatin dose (Spearman rho, 0.21) and with younger age (Spearman rho, -0.33). Urine platinum was not associated with postinfusion AKIor KIM-1, but was weakly associated with NGAL, particularly in participants without SCr AKI (Pearson's r, 0.22). Urine platinum may be a marker of mild tubular injury but is not likely to be a useful biomarker of clinically evident AKI.
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Affiliation(s)
- Asaf Lebel
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hayton Chui
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kelly R. McMahon
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Yong Jin Lim
- Schulich School of Medicine and Dentistry, Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Joseph Macri
- Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada
| | - Stella Wang
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Prasad Devarajan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tom D. Blydt-Hansen
- British Columbia Children's Hospital, Division of Pediatric Nephrology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bradley L. Urquhart
- Schulich School of Medicine and Dentistry, Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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6
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Bridoux F, Cockwell P, Glezerman I, Gutgarts V, Hogan JJ, Jhaveri KD, Joly F, Nasr SH, Sawinski D, Leung N. Kidney injury and disease in patients with haematological malignancies. Nat Rev Nephrol 2021; 17:386-401. [PMID: 33785910 DOI: 10.1038/s41581-021-00405-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) is common in patients with cancer, especially in those with haematological malignancies. Kidney injury might be a direct consequence of the underlying haematological condition. For example, in the case of lymphoma infiltration or extramedullary haematopoiesis, it might be caused by a tumour product; in the case of cast nephropathy it might be due to the presence of monoclonal immunoglobulin; or it might result from tumour complications, such as hypercalcaemia. Kidney injury might also be caused by cancer treatment, as many chemotherapeutic agents are nephrotoxic. High-intensity treatments, such as high-dose chemotherapy followed by haematopoietic stem cell transplantation, not only increase the risk of infection but can also cause AKI through various mechanisms, including viral nephropathies, engraftment syndrome and sinusoidal obstruction syndrome. Some conditions, such as thrombotic microangiopathy, might also result directly from the haematological condition or the treatment. Novel immunotherapies, such as immune checkpoint inhibitors and chimeric antigen receptor T cell therapy, can also be nephrotoxic. As new therapies for haematological malignancies with increased anti-tumour efficacy and reduced toxicity are developed, the number of patients receiving these treatments will increase. Clinicians must gain a good understanding of the different mechanisms of kidney injury associated with cancer to better care for these patients.
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Affiliation(s)
- Frank Bridoux
- Department of Nephrology, and Centre d'Investigation Clinique (CIC INSERM 1402), Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France.,CNRS, UMR7276, Limoges, France.,Centre de référence Amylose AL et autres maladies par dépôt d'immunoglobulines monoclonales, Poitiers, France
| | - Paul Cockwell
- Department of Nephrology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ilya Glezerman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Victoria Gutgarts
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Jonathan J Hogan
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| | - Florent Joly
- Department of Nephrology, and Centre d'Investigation Clinique (CIC INSERM 1402), Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Deirdre Sawinski
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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7
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McMahon KR, Rassekh SR, Schultz KR, Blydt-Hansen T, Cuvelier GDE, Mammen C, Pinsk M, Carleton BC, Tsuyuki RT, Ross CJD, Palijan A, Huynh L, Yordanova M, Crépeau-Hubert F, Wang S, Boyko D, Zappitelli M. Epidemiologic Characteristics of Acute Kidney Injury During Cisplatin Infusions in Children Treated for Cancer. JAMA Netw Open 2020; 3:e203639. [PMID: 32383745 PMCID: PMC7210480 DOI: 10.1001/jamanetworkopen.2020.3639] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Few multicenter pediatric studies have comprehensively described the epidemiologic characteristics of cisplatin-associated acute kidney injury using standardized definitions. OBJECTIVE To examine the rate of and risk factors associated with acute kidney injury among children receiving cisplatin infusions. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study examined children (aged <18 years) recruited from May 23, 2013, to March 31, 2017, at 12 Canadian pediatric academic health centers who were receiving 1 or more cisplatin infusion. Children whose estimated or measured glomerular filtration rate (GFR) was less than 30 mL/min/1.73 m2 or who had received a kidney transplant were excluded. Data analysis was performed from January 3, 2018, to September 20, 2019. EXPOSURES Cisplatin infusions. MAIN OUTCOMES AND MEASURES The primary outcome was acute kidney injury during cisplatin infusion, defined using a Kidney Disease: Improving Global Outcomes serum creatinine criteria-based definition (stage 1 or higher). The secondary outcome was acute kidney injury defined by electrolyte criteria from the National Cancer Institute Common Terminology Criteria for Adverse Events (grade 1 or higher). Assessments occurred at early (first or second cycle) and late (last or second to last cycle) cisplatin infusions. RESULTS A total of 159 children (mean [SD] age at early cisplatin infusion, 7.2 [5.3] years; 80 [50%] male) participated. The most common diagnoses were central nervous system tumors (58 [36%]), neuroblastoma (43 [27%]), and osteosarcoma (33 [21%]). Acute kidney injury (by serum creatinine level increase) occurred in 48 of 159 patients (30%) at early cisplatin infusions and 23 of 143 patients (16%) at late cisplatin infusions. Acute kidney injury (by electrolyte abnormalities) occurred in 106 of 159 patients (67%) at early cisplatin infusion and 100 of 143 patients (70%) at late cisplatin infusions. Neuroblastoma diagnosis and higher precisplatin GFR were independently associated with acute kidney injury (serum creatinine level increase) at early cisplatin infusions (adjusted odds ratio [aOR] for neuroblastoma vs other, 3.25; 95% CI, 1.18-8.95; aOR for GFR, 1.01; 95% CI, 1.00-1.03) and late cisplatin infusions (aOR for neuroblastoma vs other, 6.85; 95% CI, 1.23-38.0; aOR for GFR, 1.01; 95% CI, 1.00-1.03). Higher cisplatin infusion dose was also independently associated with acute kidney injury (serum creatinine level increase) at later cisplatin infusions (aOR, 1.05; 95% CI, 1.01-1.10). CONCLUSIONS AND RELEVANCE The findings suggest that acute kidney injury is common among children receiving cisplatin infusions and that rate and risk factors differ at earlier vs later infusions. These results may help with risk stratification with a goal of risk reduction.
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Affiliation(s)
- Kelly R. McMahon
- Research Institute of the McGill University Health Centre, Montreal Children’s Hospital, Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Shahrad Rod Rassekh
- British Columbia Children’s Hospital, Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirk R. Schultz
- British Columbia Children’s Hospital, Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Blydt-Hansen
- British Columbia Children’s Hospital, Division of Pediatric Nephrology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey D. E. Cuvelier
- CancerCare Manitoba, Division of Pediatric Oncology-Hematology-BMT, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cherry Mammen
- British Columbia Children’s Hospital, Division of Pediatric Nephrology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Maury Pinsk
- Section of Pediatric Nephrology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bruce C. Carleton
- BC Children’s Hospital Research Institute, Department of Pediatrics, Division of Translational Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ross T. Tsuyuki
- Epidemiology Coordinating and Research Centre, Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Colin J. D. Ross
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana Palijan
- Research Institute of the McGill University Health Centre, Montreal Children’s Hospital, Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Louis Huynh
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Mariya Yordanova
- Research Institute of the McGill University Health Centre, Montreal Children’s Hospital, Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Frédérik Crépeau-Hubert
- Research Institute of the McGill University Health Centre, Montreal Children’s Hospital, Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stella Wang
- Peter Gilgan Centre For Research and Learning, Toronto, Ontario, Canada
| | - Debbie Boyko
- Epidemiology Coordinating and Research Centre, Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Zappitelli
- Peter Gilgan Centre For Research and Learning, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Now with Toronto Hospital for Sick Children, Department of Pediatrics, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
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8
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Sprangers B, Lapman S. The growing pains of ifosfamide. Clin Kidney J 2020; 13:500-503. [PMID: 32897272 PMCID: PMC7467579 DOI: 10.1093/ckj/sfaa017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/22/2020] [Indexed: 11/14/2022] Open
Abstract
Ifosfamide is a commonly used chemotherapeutic known to have numerous adverse kidney manifestations. In this issue of Clinical Kidney Journal, Ensergueix et al. report a multicentric observational retrospective French study on 34 adult patients with tubular dysfunction and /or kidney dysfunction following ifosfamide treatment. Of these patients, 18% had isolated proximal tubular dysfunction, 14% had isolated acute kidney injury (AKI), 18% had isolated chronic kidney disease (CKD) and 50% had a combination of proximal tubular dysfunction and AKI. Concomitant treatment with cisplatin was identified as a risk factor for the development of AKI, and cisplatin and age were associated with estimated glomerular filtration rate at last follow-up. Interestingly, the cumulative dose of ifosfamide was not associated with renal outcomes. This report highlights the need for additional studies on the prevalence, spectrum and management of ifosfamide-associated nephrotoxicity and clearly demonstrates that patients who received ifosfamide should be followed long term to detect proximal tubular dysfunction and CKD early.
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Affiliation(s)
- Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Leuven, Belgium.,Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Sebastian Lapman
- Division of Onconephrology, Sanatorio Modelo de Caseros and Henry Moore Institute, Buenos Aires, Argentina
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9
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Park SE, Hwang JH, Choi JH, Kim SH, Choi JC, Jang JS, Kim HJ, Park SW, Seok JW, Hwang IG. Incidence, Risk Factors, and Clinical Outcomes of Acute Kidney Injury Caused by Palliative Chemotherapy in Lung Cancer. J Cancer 2019; 10:5332-5338. [PMID: 31632478 PMCID: PMC6775698 DOI: 10.7150/jca.28399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/11/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose: Acute kidney injury (AKI) affects cancer therapy outcome and increases morbidity and mortality in cancer patients. We investigated the incidence, risk factors, and clinical outcomes of AKI caused by palliative chemotherapy in lung cancer patients. Materials and Methods: Between January 2005 and November 2014, 207 lung cancer patients who had been treated with first-line palliative chemotherapy were enrolled. Renal function was assessed during every cycle of chemotherapy. AKI was defined based on changes in serum creatinine levels as described in the Kidney Disease: Improving Global Outcomes guidelines. Clinical outcomes were evaluated depending on AKI occurrence during the first-line chemotherapy. Results: Of the 207 patients, 36 (17.4%) experienced AKI. Among the 36 patients who developed AKI during chemotherapy, 33 (91.8%) had AKI stage I. Although 19 patients (52.7%) with AKI during chemotherapy progressed to chronic kidney disease (CKD), no patients were reported to progress to end-stage renal disease (ESRD). The number of chemotherapy cycles was independently associated with chemotherapy-induced AKI in multivariate analysis (OR = 1.71, 95% CI 1.29-2.26, p < 0.001). The median follow-up duration was 83 months. Patients with AKI during chemotherapy (AKI group) showed significantly longer time to treatment failure than patients without AKI (non-AKI group) (4.2 vs. 2.5 months, p < 0.001). However, the median overall survival (11.7 vs. 8.8 months, p = 0.147) and progression-free survival (5.5 vs. 5.2 months, p = 0.347) were not different between the groups. Conclusions: AKI that developed during chemotherapy was mostly of mild degree and its prognosis was favorable. The occurrence of AKI was associated with the number of chemotherapy cycles administered. AKI did not adversely affect survival of lung cancer patients during chemotherapy.
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Affiliation(s)
- Song Ee Park
- Division of Hemato-oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su-Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Chol Choi
- Division of Pulmonology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joung Soon Jang
- Division of Hemato-oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Jun Kim
- Division of Hemato-oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Suk Won Park
- Department of Radiation Oncology, Myungji Hospital, Goyang, Korea
| | - Ju Won Seok
- Department of Nuclear Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Gyu Hwang
- Division of Hemato-oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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10
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Kooijmans ECM, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen‐den Broeder E, van der Pal HJH, Veening MA. Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev 2019; 3:CD008944. [PMID: 30855726 PMCID: PMC6410614 DOI: 10.1002/14651858.cd008944.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improvements in diagnostics and treatment for paediatric malignancies resulted in a major increase in survival. However, childhood cancer survivors (CCS) are at risk of developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is a known side effect of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate (GFR) impairment, proteinuria, tubulopathy, and hypertension. Evidence about the long-term effects of these treatments on renal function remains inconclusive. It is important to know the risk of, and risk factors for, early and late adverse renal effects, so that ultimately treatment and screening protocols can be adjusted. This review is an update of a previously published Cochrane Review. OBJECTIVES To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with the general population or CCS treated without potentially nephrotoxic treatment. In addition, to evaluate evidence on associated risk factors, such as follow-up duration, age at time of diagnosis and treatment combinations, as well as the effect of doses. SEARCH METHODS On 31 March 2017 we searched the following electronic databases: CENTRAL, MEDLINE and Embase. In addition, we screened reference lists of relevant studies and we searched the congress proceedings of the International Society of Pediatric Oncology (SIOP) and The American Society of Pediatric Hematology/Oncology (ASPHO) from 2010 to 2016/2017. SELECTION CRITERIA Except for case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment), in CCS treated before the age of 21 years with cisplatin, carboplatin, ifosfamide, radiation involving the kidney region, a nephrectomy, or a combination of two or more of these treatments. When not all treatment modalities were described or the study group of interest was unclear, a study was not eligible for the evaluation of prevalence. We still included it for the assessment of risk factors if it had performed a multivariable analysis. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction using standardised data collection forms. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Apart from the remaining 37 studies included from the original review, the search resulted in the inclusion of 24 new studies. In total, we included 61 studies; 46 for prevalence, six for both prevalence and risk factors, and nine not meeting the inclusion criteria, but assessing risk factors. The 52 studies evaluating the prevalence of renal dysfunction included 13,327 participants of interest, of whom at least 4499 underwent renal function testing. The prevalence of adverse renal effects ranged from 0% to 84%. This variation may be due to diversity of included malignancies, received treatments, reported outcome measures, follow-up duration and the methodological quality of available evidence.Seven out of 52 studies, including 244 participants, reported the prevalence of chronic kidney disease, which ranged from 2.4% to 32%.Of these 52 studies, 36 studied a decreased (estimated) GFR, including at least 432 CCS, and found it was present in 0% to 73.7% of participants. One eligible study reported an increased risk of glomerular dysfunction after concomitant treatment with aminoglycosides and vancomycin in CCS receiving total body irradiation (TBI). Four non-eligible studies assessing a total cohort of CCS, found nephrectomy and (high-dose (HD)) ifosfamide as risk factors for decreased GFR. The majority also reported cisplatin as a risk factor. In addition, two non-eligible studies showed an association of a longer follow-up period with glomerular dysfunction.Twenty-two out of 52 studies, including 851 participants, studied proteinuria, which was present in 3.5% to 84% of participants. Risk factors, analysed by three non-eligible studies, included HD cisplatin, (HD) ifosfamide, TBI, and a combination of nephrectomy and abdominal radiotherapy. However, studies were contradictory and incomparable.Eleven out of 52 studies assessed hypophosphataemia or tubular phosphate reabsorption (TPR), or both. Prevalence ranged between 0% and 36.8% for hypophosphataemia in 287 participants, and from 0% to 62.5% for impaired TPR in 246 participants. One non-eligible study investigated risk factors for hypophosphataemia, but could not find any association.Four out of 52 studies, including 128 CCS, assessed the prevalence of hypomagnesaemia, which ranged between 13.2% and 28.6%. Both non-eligible studies investigating risk factors identified cisplatin as a risk factor. Carboplatin, nephrectomy and follow-up time were other reported risk factors.The prevalence of hypertension ranged from 0% to 50% in 2464 participants (30/52 studies). Risk factors reported by one eligible study were older age at screening and abdominal radiotherapy. A non-eligible study also found long follow-up time as risk factor. Three non-eligible studies showed that a higher body mass index increased the risk of hypertension. Treatment-related risk factors were abdominal radiotherapy and TBI, but studies were inconsistent.Because of the profound heterogeneity of the studies, it was not possible to perform meta-analyses. Risk of bias was present in all studies. AUTHORS' CONCLUSIONS The prevalence of adverse renal effects after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region, nephrectomy, or any combination of these, ranged from 0% to 84% depending on the study population, received treatment combination, reported outcome measure, follow-up duration and methodological quality. With currently available evidence, it was not possible to draw solid conclusions regarding the prevalence of, and treatment-related risk factors for, specific adverse renal effects. Future studies should focus on adequate study designs and reporting, including large prospective cohort studies with adequate control groups when possible. In addition, these studies should deploy multivariable risk factor analyses to correct for possible confounding. Next to research concerning known nephrotoxic therapies, exploring nephrotoxicity after new therapeutic agents is advised for future studies. Until more evidence becomes available, CCS should preferably be enrolled into long-term follow-up programmes to monitor their renal function and blood pressure.
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Affiliation(s)
- Esmee CM Kooijmans
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Arend Bökenkamp
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatric NephrologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nic S Tjahjadi
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Jesse M Tettero
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Helena JH van der Pal
- Princess Maxima Center for Pediatric Oncology, KE.01.129.2PO Box 85090UtrechtNetherlands3508 AB
| | - Margreet A Veening
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
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11
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Long-term renal follow-up of children treated with cisplatin, carboplatin, or ifosfamide: a pilot study. Pediatr Nephrol 2018; 33:2311-2320. [PMID: 30218190 DOI: 10.1007/s00467-018-3976-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood cancer survivors treated with cisplatin, ifosfamide, or carboplatin are at risk for late kidney and blood pressure (BP) abnormalities. Few studies have comprehensively evaluated kidney outcomes and 24-h ambulatory BP monitoring (ABPM) in this population. We aimed to describe chemotherapy-associated acute kidney injury (AKI) and late kidney outcomes using standardized definitions. METHODS This was a single-center longitudinal pilot study of 23 children who participated in a previous study during cisplatin, carboplatin, or ifosfamide treatment. Medical charts were reviewed retrospectively. Available patients were approached for a study visit for blood and urine collection, BP measurement, and ABPM. AKI is defined by serum creatinine (SCr) rise (Kidney Disease: Improving Global Outcomes definition [SCr-AKI]). Electrolyte-AKI is defined by hypokalemia, hypophosphatemia, or hypomagnesemia. Chronic kidney disease (CKD) is defined by estimated glomerular filtration rate < 90 mL/min/1.73 m2, albuminuria, or proteinuria. Electrolyte-CKD is defined by low serum electrolyte concentration or electrolyte supplementation. RESULTS Median age at chemotherapy start was 8.3 years; 9/23 (39%) were boys. Fourteen out of 23 (61%) patients had SCr-AKI during therapy; all developed electrolyte-AKI. Median 5.7 years post-chemotherapy, 7/22 (32%) had CKD, 11/23 (48%) had electrolyte-CKD, and 2/20 (10%) had hypertension. Fifteen out of 23 patients (65%) had either CKD, electrolyte-CKD, or hypertension. In ten patients available for a study visit (median 4.9 years post-chemotherapy), 1/10 (10%) had hypertension by ABPM; none had masked or white coat hypertension. All ten had at least one kidney abnormality (CKD, electrolyte-CKD, office pre-hypertension, or abnormal ABPM). CONCLUSIONS Using standardized outcome definitions, children treated with cisplatin, carboplatin, or ifosfamide have a high prevalence of late kidney abnormalities. Research must elucidate best practice for post-cancer treatment follow-up and kidney complication treatment.
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12
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Yanagisawa R, Kubota N, Hidaka E, Sakashita K, Tanaka M, Nakazawa Y, Nakamura T. Cisplatin-induced nephrotoxicity in patients with advanced neuroblastoma. Pediatr Blood Cancer 2018; 65:e27253. [PMID: 29797635 DOI: 10.1002/pbc.27253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ryu Yanagisawa
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan.,Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.,Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan
| | - Noriko Kubota
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan.,Department of Laboratory Medicine, Nagano Children's Hospital, Azumino, Japan
| | - Eiko Hidaka
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan.,Department of Laboratory Medicine, Nagano Children's Hospital, Azumino, Japan
| | - Kazuo Sakashita
- Department of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Miyuki Tanaka
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomohiko Nakamura
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
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13
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Barton CD, Pizer B, Jones C, Oni L, Pirmohamed M, Hawcutt DB. Identifying cisplatin-induced kidney damage in paediatric oncology patients. Pediatr Nephrol 2018; 33:1467-1474. [PMID: 28821959 PMCID: PMC6061670 DOI: 10.1007/s00467-017-3765-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 11/06/2022]
Abstract
Cisplatin is one chemotherapeutic agent used to treat childhood cancer in numerous treatment protocols, including as a single agent. It is likely to remain in clinical use over the long term. However, cisplatin-related toxicities, including neurotoxicity and nephrotoxicity, are common, affecting treatment, day-to-day life and survival of such children. With one in 700 young adults having survived childhood cancer, patients who have completed chemotherapy that includes cisplatin can experience long-term morbidity due to treatment-related adverse reactions. A better understanding of these toxicities is essential to facilitate prevention, surveillance and management. This review article discusses the effect of cisplatin-induced nephrotoxicity (Cis-N) in children and considers the underlying mechanisms. We focus on clinical features and identification of Cis-N (e.g. investigations and biomarkers) and the importance of magnesium homeostasis and supplementation.
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Affiliation(s)
- Chris D Barton
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Oncology, Alder Hey Children's Hospital, Liverpool, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's Hospital, Liverpool, UK
| | - Caroline Jones
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, UK
| | - Louise Oni
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, UK
| | - Munir Pirmohamed
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Daniel B Hawcutt
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
- NIHR Alder Hey Clinical Research Facility, University of Liverpool, Liverpool, UK.
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14
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Tibúrcio FR, Rodrigues KEDS, Belisário AR, Simões-e-Silva AC. Glomerular hyperfiltration and β-2 microglobulin as biomarkers of incipient renal dysfunction in cancer survivors. Future Sci OA 2018; 4:FSO333. [PMID: 30271618 PMCID: PMC6153459 DOI: 10.4155/fsoa-2018-0045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
Herein, we aimed to evaluate the occurrence of impaired renal function after cancer treatment with potentially nephrotoxic chemotherapy in children. A cross-sectional study was performed in 41 cancer survivors after chemotherapy with potentially nephrotoxic drugs. 26 (63.4%) children were detected with glomerular hyperfiltration, and urinary levels of β-2 microglobulin (B2MG) were higher than reference range in all patients. Levels of B2MG were positively correlated with plasma creatinine and negatively correlated with glomerular filtration rate. Plasma creatinine, systolic blood pressure and cholesterol were independently associated with B2MG values. The final multivariate model for glomerular hyperfiltration risk included plasma levels of urea and of magnesium. Urinary levels of B2MG and glomerular hyperfiltration may emerge as potential biomarkers of early renal dysfunction in childhood cancer survivors.
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Affiliation(s)
- Fernanda R Tibúrcio
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Karla E de S Rodrigues
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - André R Belisário
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Simões-e-Silva
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Pediatric Nephrology Unity, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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15
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McMahon KR, Rod Rassekh S, Schultz KR, Pinsk M, Blydt-Hansen T, Mammen C, Tsuyuki RT, Devarajan P, Cuvelier GDE, Mitchell LG, Baruchel S, Palijan A, Carleton BC, Ross CJD, Zappitelli M. Design and Methods of the Pan-Canadian Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) Nephrotoxicity Study: A Prospective Observational Cohort Study. Can J Kidney Health Dis 2017; 4:2054358117690338. [PMID: 28270931 PMCID: PMC5317038 DOI: 10.1177/2054358117690338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/14/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Childhood cancer survivors experience adverse drug events leading to lifelong health issues. The Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) team was established to validate and apply biomarkers of cancer treatment effects, with a goal of identifying children at high risk of developing cancer treatment complications associated with thrombosis, graft-versus-host disease, hearing loss, and kidney damage. Cisplatin is a chemotherapy well known to cause acute and chronic nephrotoxicity. Data on biomarkers of acute kidney injury (AKI) and late renal outcomes in children treated with cisplatin are limited. OBJECTIVE To describe the design and methods of the pan-Canadian ABLE Nephrotoxicity study, which aims to evaluate urine biomarkers (neutrophil gelatinase-associated lipocalin [NGAL] and kidney injury molecule-1 [KIM-1]) for AKI diagnosis, and determine whether they predict risk of long-term renal outcomes (chronic kidney disease [CKD], hypertension). DESIGN This is a 3-year observational prospective cohort study. SETTING The study includes 12 Canadian pediatric oncology centers. PATIENTS The target recruitment goal is 150 patients aged less than 18 years receiving cisplatin. Exclusion criteria: Patients with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 or a pre-existing renal transplantation at baseline. MEASUREMENTS Serum creatinine (SCr), urine NGAL, and KIM-1 are measured during cisplatin infusion episodes (pre-infusion, immediate post-infusion, discharge sampling). At follow-up visits, eGFR, microalbuminuria, and blood pressure are measured and outcomes are collected. METHODS Outcomes: AKI is defined as per SCr criteria of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. CKD is defined as eGFR <90 mL/min/1.73m2 or albumin-to-creatinine ratio≥3mg/mmol. Hypertension is defined as per guidelines. Procedure: Patients are recruited before their first or second cisplatin cycle. Participants are evaluated during 2 cisplatin infusion episodes (AKI biomarker validation) and at 3, 12, and 36 months post-cisplatin treatment (late outcomes). LIMITATIONS The study has a relatively moderate sample size and short follow-up duration. There is potential for variability in data collection since multiple sites are involved. CONCLUSIONS ABLE will provide a national platform to study biomarkers of late cancer treatment complications. The Nephrotoxicity study is a novel study of AKI biomarkers in children treated with cisplatin that will greatly inform on late cisplatin renal outcomes and follow-up needs.
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Affiliation(s)
- Kelly R. McMahon
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Canada
| | - Shahrad Rod Rassekh
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Kirk R. Schultz
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Maury Pinsk
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - Tom Blydt-Hansen
- Department of Pediatrics, Division of Pediatric Nephrology, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Cherry Mammen
- Department of Pediatrics, Division of Pediatric Nephrology, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Ross T. Tsuyuki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Prasad Devarajan
- Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, OH, USA
| | - Geoff D. E. Cuvelier
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - Lesley G. Mitchell
- Department of Pediatrics, Division of Hematology/Oncology, Stollery Children’s Hospital, University of Alberta, Edmonton, Canada
| | - Sylvain Baruchel
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Ana Palijan
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Canada
| | - Bruce C. Carleton
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Colin J. D. Ross
- Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Canada
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16
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Jiménez-Triana CA, Castelán-Martínez OD, Rivas-Ruiz R, Jiménez-Méndez R, Medina A, Clark P, Rassekh R, Castañeda-Hernández G, Carleton B, Medeiros M. Cisplatin Nephrotoxicity and Longitudinal Growth in Children With Solid Tumors: A Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e1413. [PMID: 26313789 PMCID: PMC4602918 DOI: 10.1097/md.0000000000001413] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cisplatin, a major antineoplastic drug used in the treatment of solid tumors, is a known nephrotoxin. This retrospective cohort study evaluated the prevalence and severity of cisplatin nephrotoxicity in 54 children and its impact on height and weight.We recorded the weight, height, serum creatinine, and electrolytes in each cisplatin cycle and after 12 months of treatment. Nephrotoxicity was graded as follows: normal renal function (Grade 0); asymptomatic electrolyte disorders, including an increase in serum creatinine, up to 1.5 times baseline value (Grade 1); need for electrolyte supplementation <3 months and/or increase in serum creatinine 1.5 to 1.9 times from baseline (Grade 2); increase in serum creatinine 2 to 2.9 times from baseline or need for electrolyte supplementation for more than 3 months after treatment completion (Grade 3); and increase in serum creatinine ≥3 times from baseline or renal replacement therapy (Grade 4).Nephrotoxicity was observed in 41 subjects (75.9%). Grade 1 nephrotoxicity was observed in 18 patients (33.3%), Grade 2 in 5 patients (9.2%), and Grade 3 in 18 patients (33.3%). None had Grade 4 nephrotoxicity. Nephrotoxicity patients were younger and received higher cisplatin dose, they also had impairment in longitudinal growth manifested as statistically significant worsening on the height Z Score at 12 months after treatment. We used a multiple logistic regression model using the delta of height Z Score (baseline-12 months) as dependent variable in order to adjust for the main confounder variables such as: germ cell tumor, cisplatin total dose, serum magnesium levels at 12 months, gender, and nephrotoxicity grade. Patients with nephrotoxicity Grade 1 where at higher risk of not growing (OR 5.1, 95% CI 1.07-24.3, P=0.04). The cisplatin total dose had a significant negative relationship with magnesium levels at 12 months (Spearman r=-0.527, P=<0.001).
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Affiliation(s)
- Clímaco Andres Jiménez-Triana
- From the Departamento de Nefrología, Hospital Infantil de México Federico Gómez (CAJ-T); Unidad de Investigación en Epidemiología Clínica, Hospital Infantil de México Federico Gómez (ODC-M, PC); Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (RR-R); Facultad de Medicina de la Universidad Nacional Autónoma de México, México D.F., México (RR-R, PC); Pharmaceutical Outcomes Programme, BC Children's Hospital (RJ-M, BC); Division of Translational Therapeutics, Department of Paediatrics, Faculty of Medicine, University of British Columbia (BC, RJ-M); Child&Family Research Institute, Vancouver, Canada (RJ-M, BC); Departamento de Oncología, Hospital Infantil de México Federico Gómez, México D.F., México (AM); Department of Oncology, BC Children's Hospital Vancouver, Canada (RR); Departamento de Farmacología, CINVESTAV IPN (GC-H); Laboratorio de Investigación en Nefrología y Metabolismo Mineral, Hospital Infantil de México Federico Gómez (MM); and Departamento de Farmacología, Facultad de Medicina UNAM, México D.F., México (MM)
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Faught LN, Greff MJE, Rieder MJ, Koren G. Drug-induced acute kidney injury in children. Br J Clin Pharmacol 2015; 80:901-9. [PMID: 25395343 DOI: 10.1111/bcp.12554] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/12/2014] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a serious problem occurring in anywhere between 8 and 30% of children in the intensive care unit. Up to 25% of these cases are believed to be the result of pharmacotherapy. In this review we have focused on several relevant drugs and/or drug classes, which are known to cause AKI in children, including cancer chemotherapeutics, non-steroidal anti-inflammatory drugs and antimicrobials. AKI demonstrates a steady association with increased long term risk of poor outcomes including chronic kidney disease and death as determined by the extent of injury. For this reason it is important to understand the causality and implications of these drugs and drug classes. Children occupy a unique patient population, advocating the importance of understanding how they are affected dissimilarly compared with adults. While the kidney itself is likely more susceptible to injury than other organs, the inherent toxicity of these drugs also plays a major role in the resulting AKI. Mechanisms involved in the toxicity of these drugs include oxidative damage, hypersensitivity reactions, altered haemodynamics and tubule obstruction and may affect the glomerulus and/or the tubules. Understanding these mechanisms is critical in determining the most effective strategies for treatment and/or prevention, whether these strategies are less toxic versions of the same drugs or add-on agents to mitigate the toxic effect of the existing therapy.
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Affiliation(s)
- Lauren N Faught
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Ivey Chair in Molecular Toxicology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Michael J Rieder
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Department of Pediatrics, Western University, London, Ontario, Canada.,CIHR-GSK Chair in Paediatric Clinical Pharmacology, Children's Hospital of Western Ontario, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada
| | - Gideon Koren
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Ivey Chair in Molecular Toxicology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pediatrics, Western University, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Prasaja Y, Sutandyo N, Andrajati R. Incidence of Cisplatin-Induced Nephrotoxicity and Associated Factors among Cancer Patients in Indonesia. Asian Pac J Cancer Prev 2015; 16:1117-22. [DOI: 10.7314/apjcp.2015.16.3.1117] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Valentovic MA, Ball JG, Brown JM, Terneus MV, McQuade E, Van Meter S, Hedrick HM, Roy AA, Williams T. Resveratrol attenuates cisplatin renal cortical cytotoxicity by modifying oxidative stress. Toxicol In Vitro 2014; 28:248-57. [PMID: 24239945 PMCID: PMC3924893 DOI: 10.1016/j.tiv.2013.11.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/05/2013] [Accepted: 11/05/2013] [Indexed: 01/05/2023]
Abstract
Cisplatin, a cancer chemotherapy drug, is nephrotoxic. The aim of this study was to investigate whether resveratrol (RES) reduced cisplatin cytotoxicity and oxidative stress. Rat renal cortical slices were pre-incubated 30min with 0 (VEH, ethanol) or 30μg/ml RES followed by 60, 90 or 120min co-incubation with 0, 75, or 150μg/ml cisplatin. Lactate dehydrogenase (LDH) leakage was unchanged at 60 and 90min by cisplatin. Cisplatin increased (p<0.05) LDH leakage at 120min which was protected by RES. Cisplatin induced oxidative stress prior to LDH leakage as cisplatin depressed glutathione peroxidase and superoxide dismutase (SOD) activity, increased lipid peroxidation, protein carbonyls and 4-hydroxynonenal (4-HNE) adducted proteins within 60min. RES failed to reverse glutathione (GSH) depression by cisplatin. In order to eliminated an extracellular interaction between RES and cisplatin, additional studies (RINSE studies) allowed a 30min RES uptake into slices, transfer of slices to buffer lacking RES, followed by 120min cisplatin incubation. RES in the RINSE studies prevented LDH leakage by cisplatin indicating that RES protection was not via a physical interaction with cisplatin in the media. These findings indicate that RES diminished cisplatin in vitro renal toxicity and prevented the development of oxidative stress.
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Affiliation(s)
- Monica A Valentovic
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States.
| | - John G Ball
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - J Mike Brown
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | | | - Elizabeth McQuade
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Stephanie Van Meter
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Hayden M Hedrick
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Amy Allison Roy
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Tierra Williams
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
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Knijnenburg SL, Mulder RL, Schouten-Van Meeteren AYN, Bökenkamp A, Blufpand H, van Dulmen-den Broeder E, Veening MA, Kremer LCM, Jaspers MWM. Early and late renal adverse effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev 2013:CD008944. [PMID: 24101439 DOI: 10.1002/14651858.cd008944.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Great improvements in diagnostics and treatment for malignant disease in childhood have led to a major increase in survival. However, childhood cancer survivors (CCS) are at great risk for developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is one of these known (acute) side effects of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate impairment, proteinuria, tubulopathy and hypertension. However, evidence about the long-term effects of these treatments on renal function remains inconclusive. To reduce the number of (long-term) nephrotoxic events in CCS, it is important to know the risk of, and risk factors for, early and late renal adverse effects, so that ultimately treatment and screening protocols can be adjusted. OBJECTIVES To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of and associated risk factors for renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with healthy controls or CCS treated without potentially nephrotoxic treatment. SEARCH METHODS We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2011), MEDLINE/PubMed (from 1945 to December 2011) and EMBASE/Ovid (from 1980 to December 2011). SELECTION CRITERIA With the exception of case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment) in children and adults who were treated for a paediatric malignancy (aged 18 years or younger at diagnosis) with cisplatin, carboplatin, ifosfamide, radiation including the kidney region and/or a nephrectomy. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction using standardised data collection forms. Analyses were performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS The search strategy identified 5504 studies, of which 5138 were excluded on the basis of title and/or abstract. The full-text screening of the remaining 366 articles resulted in the inclusion of 57 studies investigating the prevalence of and sometimes also risk factors for early and late renal adverse effects of treatment for childhood cancer. The 57 studies included at least 13,338 participants of interest for this study, of whom at least 6516 underwent renal function testing. The prevalence of renal adverse effects ranged from 0% to 84%. This variation may be due to diversity in included malignancies, prescribed treatments, reported outcome measurements and the methodological quality of available evidence.Chronic kidney disease/renal insufficiency (as defined by the authors of the original studies) was reported in 10 of 57 studies. The prevalence of chronic kidney disease ranged between 0.5% and 70.4% in the 10 studies and between 0.5% and 18.8% in the six studies that specifically investigated Wilms' tumour survivors treated with a unilateral nephrectomy.A decreased (estimated) glomerular filtration rate was present in 0% to 50% of all assessed survivors (32/57 studies). Total body irradiation; concomitant treatment with aminoglycosides, vancomycin, amphotericin B or cyclosporin A; older age at treatment and longer interval from therapy to follow-up were significant risk factors reported in multivariate analyses. Proteinuria was present in 0% to 84% of all survivors (17/57 studies). No study performed multivariate analysis to assess risk factors for proteinuria.Hypophosphataemia was assessed in seven studies. Reported prevalences ranged between 0% and 47.6%, but four of seven studies found a prevalence of 0%. No studies assessed risk factors for hypophosphataemia using multivariate analysis. The prevalence of impairment of tubular phosphate reabsorption was mostly higher (range 0% to 62.5%; 11/57 studies). Higher cumulative ifosfamide dose, concomitant cisplatin treatment, nephrectomy and longer follow-up duration were significant risk factors for impaired tubular phosphate reabsorption in multivariate analyses.Treatment with cisplatin and carboplatin was associated with a significantly lower serum magnesium level in multivariate analysis, and the prevalence of hypomagnesaemia ranged between 0% and 37.5% in the eight studies investigating serum magnesium.Hypertension was investigated in 24 of the 57 studies. Reported prevalences ranged from 0% to 18.2%. A higher body mass index was the only significant risk factor noted in more than one multivariate analysis. Other reported factors that significantly increased the risk of hypertension were use of total body irradiation, abdominal irradiation, acute kidney injury, unrelated or autologous stem cell donor type, growth hormone therapy and older age at screening. Previous infection with hepatitis C significantly decreased the risk of hypertension.Because of the profound heterogeneity of the studies, it was not possible to perform any meta-analysis. AUTHORS' CONCLUSIONS The prevalence of renal adverse events after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region and/or nephrectomy ranged from 0% to 84%. With currently available evidence, it was not possible to draw any conclusions with regard to prevalence of and risk factors for renal adverse effects. Future studies should focus on adequate study design and reporting and should deploy multivariate risk factor analysis to correct for possible confounding. Until more evidence becomes available, CCS should be enrolled into long-term follow-up programmes to monitor their renal function and blood pressure.
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Abstract
Ifosfamide (IFA) is a powerful chemotherapeutic drug that is active against a variety of paediatric malignancies. However, renal toxicities such as haemorrhagic cystitis and Fanconi syndrome are major hazards that hinder its use in clinical practice. The authors present a case of a patient treated for Wilms' tumour with IFA who developed rickets with Fanconi syndrome. Patients undergoing IFA treatment must be carefully monitored for the development of iatrogenic complications. Recent studies have improved our understanding of the underlying pathomechanism of IFA induced Fanconi syndrome, and selective renal protection against during chemotherapy with IFA may be possible soon.
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Sánchez-González PD, López-Hernández FJ, López-Novoa JM, Morales AI. An integrative view of the pathophysiological events leading to cisplatin nephrotoxicity. Crit Rev Toxicol 2011; 41:803-21. [DOI: 10.3109/10408444.2011.602662] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Kobayashi Y, Kawakami K, Ohbayashi M, Kohyama N, Yamamoto T. Ribosomal protein L3 mediated the transport of digoxin in Xenopus laevis oocyte. J Toxicol Sci 2011; 35:827-34. [PMID: 21139332 DOI: 10.2131/jts.35.827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Ribosomal protein L3 (RPL3) is known to be an indispensable and essential component for the peptidyltransferase center. In the present study, we found a novel function of RPL3 using a Xenopus laevis oocyte expression system. When expressed in X. oocytes, RPL3 mediated the high affinity transport of [(3)H]digoxin (K(m) = 213.3 ± 46.8 nM) in a time-, concentration-, and sodium-dependent manners. The maximum velocity of the transport of [(3)H]digoxin via RPL3 produced at physiological pH. However, we did not observe RPL3-mediated transport of several organic solutes such as [(14)C]androstenedione, [(3)H]dexamethasone, [(3)H]dehydroepiandrosterone sulfate, [(3)H]L-tryptophan, [(14)C]L-ascorbic acid, [(14)C]α-ketoglutarate, [(14)C]glutarate, [(3)H]methotrexate, [(3)H]bumetanide, [(3)H]probenecid, [(14)C]salicylic acid, [(14)C]theophylline and [(3)H]valproate. Our results suggest that RPL3 functions as a drug carrier protein and may be involved in the digoxin toxicity in the human body.
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Affiliation(s)
- Yasuna Kobayashi
- Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan
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Giraud B, Hebert G, Deroussent A, Veal GJ, Vassal G, Paci A. Oxazaphosphorines: new therapeutic strategies for an old class of drugs. Expert Opin Drug Metab Toxicol 2010; 6:919-38. [DOI: 10.1517/17425255.2010.487861] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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