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World J Clin Oncol. Apr 24, 2020; 11(4): 190-204
Published online Apr 24, 2020. doi: 10.5306/wjco.v11.i4.190
Nephrotoxicity in cancer treatment: An overview
Maria Luísa Cordeiro Santos, Breno Bittencourt de Brito, Filipe Antônio França da Silva, Anelise Costa dos Santos Botelho, Fabrício Freire de Melo
Maria Luísa Cordeiro Santos, Breno Bittencourt de Brito, Filipe Antônio França da Silva, Anelise Costa dos Santos Botelho, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Bahia, Brazil
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fabrício Freire de Melo, PhD, Postdoctoral Fellow, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Vitória da Conquista 45029094, Bahia, Brazil. freiremelo@yahoo.com.br
Received: December 29, 2019
Peer-review started: December 29, 2019
First decision: January 19, 2020
Revised: January 24, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 24, 2020
Processing time: 115 Days and 6.6 Hours
Abstract

Anticancer drug nephrotoxicity is an important and increasing adverse drug event that limits the efficacy of cancer treatment. The kidney is an important elimination pathway for many antineoplastic drugs and their metabolites, which occurs by glomerular filtration and tubular secretion. Chemotherapeutic agents, both conventional cytotoxic agents and molecularly targeted agents, can affect any segment of the nephron including its microvasculature, leading to many clinical manifestations such as proteinuria, hypertension, electrolyte disturbances, glomerulopathy, acute and chronic interstitial nephritis, acute kidney injury and at times chronic kidney disease. The clinician should be alert to recognize several factors that may maximize renal dysfunction and contribute to the increased incidence of nephrotoxicity associated with these drugs, such as intravascular volume depletion, the associated use of nonchemotherapeutic nephrotoxic drugs (analgesics, antibiotics, proton pump inhibitors, and bone-targeted therapies), radiographic ionic contrast media or radiation therapy, urinary tract obstruction, and intrinsic renal disease. Identification of patients at higher risk for nephrotoxicity may allow the prevention or at least reduction in the development and severity of this adverse effect. Therefore, the aim of this brief review is to provide currently available evidences on oncologic drug-related nephrotoxicity.

Keywords: Acute kidney injury; Cancer; Chemotherapy; Conventional cytotoxic agents; Molecularly targeted agents; Nephrotoxicity

Core tip: Nephrotoxicity is an adverse event that is well described with the use of conventional cytotoxic agents and with the advent of new agents directed to specific genes/proteins in recent decades. Its nephrotoxic potential has also been observed, which limits the effectiveness of treatment and increases the morbidity and mortality of these patients. Our objective was to recognize the main chemotherapeutic drugs with nephrotoxic potential and the most common types of kidney injury to prevent or at least reduce their occurrence and severity, allowing better therapeutic indices.