Nephro-oncology: a link in evolution

Figures & data

Figure 1. Some examples of antineoplastic drugs according to the nephron sites primarily damaged.

Table 1. Medicaments that require dose adjustment (%) in case of pre-existing CKD.

Drugs	eGFR 50–10 mL/min	eGFR < 10 mL/min	Mechanism of kidney damage
Cisplatin	75%	50%	Inflammation, apoptosis and tubular damage
Carboplatin	50%	25%	ATN (high doses)
Ifosfamide	No adjustment	75%	RTA (high doses)
Ciclofosfamide	No adjustment	75%	SIADH
Streptozocin	75%	50%	Tubular—atrophy, glomerulosclerosis
Mitomycin C	No adjustment	75%	HUS
Mithramycin	75%	50%	ATN
Methotrexate	50%	Avoid	ATN
Pentostatin	60% if eGFR 50–30 mL/min	Avoid if eGFR <30 mL/min	HUS
Melphalan	75%	50%	Probably ATN
Carmustine	75% if eGFR 50–30 mL/min	Avoid if eGFR <30 mL/min	Tubular—atrophy, glomerulosclerosis
Lomustine	70% if eGFR 50–30 mL/min	Avoid if eGFR <30 mL/min	Tubular—atrophy, glomerulosclerosis
Zolendronic acid	50–25% if eGFR 50–30 mL/min	Avoid if eGFR <30 mL/min	ATN, FSGS

Notes: ATN, acute tubular necrosis; RTA, renal tubular acidosis; SIADH, syndrome of inappropriate antidiuretic hormone; HUS, hemolytic uremic syndrome; FSGS, focal segmental glomerulosclerosis.

Table 2. Risk factor for CI-AKI.

Pre-existing impairment of kidney function	Other risk factors
Baseline serum creatinine ≥1.3 mg/dL  (≥115 µmol/L) in men and ≥1.0 mg/dL  (≥88.4 µmol/L) in women	Diabetes
eGFR ≤60 mL/min/1.73 m^2	Hypertension
Dipstick positive proteinuria	Advanced age
	Volume depletion
	Use of nephrotoxic drugs
	Use of large volume or high osmolality of the contrast agent

Table 3. Prevention strategy in patients at risk for CI-AKI.

Non-pharmacological strategy	Pharmacological strategy
1. MACD^a = 5 × bodyweight/serum creatinine	1. Fluid administration (IsNaCl/IsNaHCO3)^b
2. Prefer venous administration	2. Oral NAC^c together with isotonic solutions
3. Avoiding high-osmolar contrast media	3. Discontinuation of NSAIDs^d
4. Consider alternative imaging methods	4. Avoiding theophyline and fenoldopam

Notes: ^aMaximum allowable contrast dose.

^bIsotonic sodium chloride solutions or isotonic bicarbonate solutions at 1.0–1.5 mL/kg/h for 3–12 h before and 6–12 h after contrast-media exposure.

^cN-acetyl-l-cysteine.

^dNon-steroidal anti-inflammatory drugs.