Side Effects > Kidney (renal) toxicity

Last update: 11/19/2014

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What do the kidneys do?

The vital role of the kidneys is to sift out waste products from the blood and to remove extra water, which becomes urine.  The urine is then stored in the bladder until urination.   How well your kidneys are working is called renal function. 

How is poor kidney function detected?

When the kidneys are not working well, the waste products normally eliminated by the kidneys will be elevated in the blood. 

During treatment, markers of kidney toxicity can be expected and may get better with time.  Your doctor will measure concentrations of the waste substances in your blood and urine to monitor renal function:

	Elevated Plasma (blood) levels of: Creatinine, blood urea nitrogen (BUN), and  electrolytes
	Elevated level of protein (proteinuria) in the urine. The most sensitive marker of proteinuria is elevated urine albumin.

Causes of Renal toxicity (nephrotoxicity)

Kidney problems can occur when your body is exposed to a drug or toxin that causes damage to your kidneys.  These effects can be temporary and mitigated by maintaining hydration (drinking water).  But there are other causes or contributing factors to poor kidney function or damage:

	Certain chemotherapy drugs
	Radiation therapy - Dr. Eric Cohen: Radiation Nephropathy http://bit.ly/11tQgm3
	Some biologic therapies, such as interferon
	Intravenous (IV) contrast for imaging
	Blockage of blood flow to or from the kidney - by kidney stones or a tumor.
	Low blood pressure or irregular heart rhythms
	Being dehydrated
	Diuretics drugs
	Urinary infection, or inflammation of one or more of your kidneys
	Some antibiotics
	Heart disease and some drugs to treat heart conditions
	NSAID drugs
	Enlarged prostate gland
	Gastrointestinal tract or stomach bleeds (GI bleed).
	Too much protein in your diet
	Low blood pressure
	Diabetes
	A blockage of blood flow to or from the kidney. This may be caused by kidney stones or a tumor. Can kidney stones cause kidney failure or damage? - KidneyStoners.org http://bit.ly/1vdJqyg
	Irregular heart rhythms can blood flow to the kidneys producing signs of kidney problems.

How to Reduce the Risk of Treatment-related Renal toxicity

	Drinking plenty of water can reduce the risk of kidney damage of many drugs prior to treatment
	Limit use of Over the Counter Drugs, such as NSAIDS (ibuprofen).
	Limit proteins in your diet
	Limit or avoid alcohol during treatment
	Limit caffeine beverages during treatment

Symptoms of kidney disease (low function of the kidney) may include:

	Appetite loss
	General ill feeling and fatigue
	Headaches
	Itching (pruritus) and dry skin
	Nausea
	Weight loss without trying to lose weight

Source: MedlinePlus Medical Encyclopedia http://1.usa.gov/1pRELRc 

Symptoms that may occur when kidney function has gotten worse include:

	Abnormally dark or light skin
	Bone pain
	Drowsiness or problems concentrating or thinking
	Numbness or swelling in the hands and feet
	Muscle twitching or cramps
	Breath odor
	Easy bruising, or blood in the stool
	Excessive thirst
	Frequent hiccups
	Problems with sexual function
	Menstrual periods stop (amenorrhea)
	Shortness of breath
	Sleep problems
	Vomiting, often in the morning

Source: MedlinePlus Medical Encyclopedia http://1.usa.gov/1pRELRc 

Diet Recommendations and resources

	USDA Nutrient Database http://1.usa.gov/1sEdiNy
	Nutritional Values For Common Foods And Products http://bit.ly/1wUgsmk
	Low-phosphorus diet: Best for kidney disease? - Mayo Clinic http://mayocl.in/1wngpvi
	Diet and Nutrition Goals for People with Stage 3 Chronic Kidney Disease - DaVita http://bit.ly/14eblTx
	Diet - chronic kidney disease: MedlinePlus Medical Encyclopedia http://1.usa.gov/1xNtNLI
	Stage 3 Kidney Disease Diet - foods to eat and avoid http://bit.ly/1xNF3Yn
	The Stage 3 CKD Low Protein Diet | LIVESTRONG.COM http://bit.ly/1tHPkkL

Resources and related reports:

	Kidney involvement in leukemia and lymphoma. - PubMed - NCBI http://1.usa.gov/1A7Rv9z
	Acute kidney injury in the cancer patient. - PubMed - NCBI http://1.usa.gov/1uyIpQe
	Chemocare: Nephrotoxicity (Renal Toxicity) - Managing Side Effects - http://bit.ly/1q0h9tL
	Chronic Kidney Disease: Prevention and Treatment of Common Complications http://www.aafp.org/afp/2004/1115/p1921.html
	WebMD: Urine Test http://bit.ly/1sYUzNO
	Tests commonly used for screening, diagnosis, and monitoring: Source: Lab Tests Online http://labtestsonline.org/understanding/conditions/kidney/start/3
	Chronic kidney disease: MedlinePlus Medical Encyclopedia http://1.usa.gov/1pRELRc
	Chemocare.com:  About Nephrotoxicity (Renal Toxicity)
	NIH: About Kidney function and disease http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/
	How to prevent, recognize, and treat drug-induced kidney toxicity - nephrotoxicity ~  - ccjm.org PDF
	Anticancer drug-induced kidney disorders. Drug Saf. 2001 Jan;24(1):19-38. Review. PMID: 11219485
	Nephrotoxicity from chemotherapy: prevention and management. Oncology (Huntingt). 1991 Oct;5(10):97-102, 105; disc. 105, 109-11. Review. PMID: 1838278
	Cisplatin Nephrotoxicity: A Review  http://medicine-opera.com/wp-content/uploads/2008/05/cisplatin-nephrotoxicity.pdf