Table 3.

Nephrotoxicity related to some anticancer drugs

Drug	Nephrotoxicity profile	Prevention or Management
Azacitidine	Fanconi syndrome, nephrogenic diabetes insipidus	Discontinuation of the drug
Carmustine	Decreased kidney perfusion induced by hypotension (resolves a few hours after completion of carmustine administration) CKD 1 to 24 mo following completion of therapy	Administration of supplemental crystalloid fluid; reduction of the carmustine infusion rate by 50% or drug discontinuation Vasopressor administration; antihypertensive medication should be discontinued 24 h preceding and withheld on the day of carmustine administration
Cyclophosphamide	SIADH, nephrogenic diabetes insipidus Hemorrhagic cystitis	Discontinuation of the drug Aggressive hydration and mesna use
Ifosfamide	Fanconi syndrome, CKD, SIADH, nephrogenic diabetes insipidus; risk factors include cumulative ifosfamide dose > 50 g/m2, preexisting GFR loss and/or nephrectomy, age ≤ 12 y, Wilms tumor, previous cisplatin treatment	If possible, ifosfamide should be discontinued in patients developing signs of moderate to severe AKI during therapy; oral and/or IV fluid and electrolyte supportive therapy should be provided
Interferon	Acute tubular necrosis and variable glomerular lesions, proteinuria in up 5%–20% of patients; normalisation of sCr level generally occurs within weeks to months of drug discontinuation; SIADH TMA	If possible, treatment with interferon alfa should be discontinued with the onset of AKI Prompt diagnosis, early discontinuation of the drug and supportive treatment may improve the outcome
IL-2	Decreased kidney perfusion induced by capillary leak syndrome; time and dose dependent; occurs 24–48 h after initiating therapy; risk factors include baseline CKD, previous hypertension, male sex, sepsis, cardiac dysfunction	Supplemental crystalloid fluid administration; diuresis; discontinuation of antihypertensive therapy prior and during IL-2 infusion
Mercaptopurine	Fanconi syndrome	Discontinuation of the drug
Mitomycin C	TMA; risk at a cumulative dose > 30 mg/m2; generally arises 4–8 wk after the end of therapy but the onset may occur immediately after treatment or up to 9 mo later; recovery is possible but CKD is usually progressive and dialysis is required in almost 1/3 of patients; case fatality rate is >50% and median time to death is ~4 wk	Prompt diagnosis, early discontinuation of the drug, and supportive treatment may improve the outcome
Streptozotocin	Fanconi syndrome, CKD, glomerular toxicity and kidney failure	Discontinuation of the drug (continued treatment generally results in irreversible injury)

Abbreviations: AKI, acute kidney injury; CKD, chronic kidney disease; SIADH: syndrome of inappropriate secretion of antidiuretic hormone; GFR, glomerular filtration rate; TMA, Thrombotic microangiopathy; sCr, serum creatinine; IL-2, interleukin 2; IV, intravenous