Table 1.

List of chemotherapy agents which cause nephrotoxicity

	Nephrotoxic mechanism	Associated conditions	Management	References
Alkylating agents	Damage to proximal and distal tubules by metabolites and increased cellular oxidative stress	SIADH induced severe hyponatremia, Fanconi’s syndrome in children	Hyponatremia management with continuous infusion or bolus hypertonic saline; adequate hydration; AVP (V2) receptor antagonist (tolvaptan); Mesna or N-acetylcysteine electrolyte monitoring; discontinuation	[3,32,33,99-101]
Cyclophosphamide
Ifosfamide
Cytotoxic agents	Drug accumulation in proximal tubules resulting in proximal tubular dysfunction	AKI, TMA, Fanconi’s syndrome, salt-wasting hyponatremia, Hypomagnesemia	Aggressive Short-duration, low-volume hydration; dose adjustment for preexisting renal impairments; magnesium supplementation; mannitol supplementation for preexisting renal impairment and high-dose cisplatin; Forced diuresis; Amifostine radical scavenger; discontinuation; eculizumab for TMA resolution	[3,21,25]
Cisplatin
Carboplatin
Antimetabolites	Vasoconstriction of afferent arteries, reducing GFR; crystal precipitation in renal tubules	Tubular acidosis, AKI, SIADH induced hyponatremia, hemolytic uremic syndrome and TMA	Urinary alkylation, hydration, high-flux hemodialysis, carboxypeptidase-G(2) (CPDG2), leucovorin rescue; oral corticosteroids; hyponatremia management with hypertonic saline infusion, fluid restriction, AVP (V2) receptor antagonist (tolvaptan); discontinuation	[3,28,29]
Methotrexate
Pemetrexed
Gemcitabine
Vinca Alkaloids	Neurotoxic effect on hypothalamus-pituitary axis resulting in altered osmotic control of ADH	SIADH induced hyponatremia	Hyponatremia management with continuous infusion or bolus hypertonic saline, fluid restriction, AVP (V2) receptor antagonist (tolvaptan); discontinuation	[3,101-103]
Vincristine
Vinblastine
Antitumor antibiotics	Induced glomerular endothelial cell and podocyte apoptosis, mesangiolysis	Focal segmental glomerular sclerosis, nephrotic syndrome, hemolytic uremic syndrome, TMA, AKI	Eculizumab for TMA resolution; nephrotic syndrome management through fluid and sodium restriction, oral or IV diuretics, and ACE inhibitors or ARBs	[3,104-107]
Doxorubicin
Mitomycin C
Proteasome inhibitors	Decreased vascular endothelial growth factor (VEGF) synthesis resulting in TMA; increased ADH secretion and effect on kidneys	Acute interstitial nephritis, TMA, AKI, Tumor lysis syndrome, SIADH induced hyponatremia	Glucocorticoid therapy for management of interstitial nephritis (inconclusive); N-acetyl-l-cysteine upon chemotherapy re-challenge (inconclusive); Hyponatremia management with continuous infusion or bolus hypertonic saline, fluid restriction, AVP (V2) receptor antagonist (tolvaptan); discontinuation	[3,39,40,51,108]
Bortezomib
Carfilzomib