Skinner Roderick
Department of Paediatric and Adolescent Oncology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
J Pediatr Hematol Oncol. 2011 Mar;33(2):128-34. doi: 10.1097/MPH.0b013e3181f8cac0.
Nephrotoxicity is the development of functional or structural kidney damage after exposure to one or more of a wide variety of drugs, other treatments or exogenous toxins, and may lead to a variety of functional consequences and structural lesions. Nephrotoxicity is important as it may occur in a substantial proportion of children treated with certain drugs and occasionally lead to severe renal impairment that may prevent the delivery of optimal anticancer treatment and/or reduce the quality of life of long-term survivors. This article describes what is currently known about nephrotoxicity occurring in children treated for malignancy by summarizing published information about the clinical characteristics and long-term outcome of, and the risk factors for the development of, ifosfamide and platinum-induced renal toxicity. Published guidelines for the evaluation and surveillance of nephrotoxicity, and the still incomplete understanding of its pathogenesis, are also outlined. Many gaps in our knowledge of nephrotoxicity are highlighted, including the lack of detailed knowledge about its overall incidence and very long-term impact, the nephrotoxic potential of new drugs, the efficacy of surveillance protocols, the relevance of proteinuria as a component of nephrotoxicity, and our current inability to reliably predict or prevent many episodes of nephrotoxicity.
肾毒性是指在接触多种药物、其他治疗方法或外源性毒素中的一种或多种后，肾脏出现功能性或结构性损伤，并可能导致多种功能后果和结构性病变。肾毒性很重要，因为在接受某些药物治疗的相当一部分儿童中可能会发生，偶尔会导致严重的肾功能损害，这可能会妨碍提供最佳的抗癌治疗和/或降低长期幸存者的生活质量。本文通过总结已发表的关于异环磷酰胺和铂类药物所致肾毒性的临床特征、长期预后及发生风险因素的信息，阐述了目前对于接受恶性肿瘤治疗的儿童发生肾毒性的了解情况。文中还概述了已发表的肾毒性评估和监测指南，以及对其发病机制仍不完整的认识。我们对肾毒性的认识存在许多空白，包括对其总体发病率和长期影响缺乏详细了解、新药的肾毒性潜力、监测方案的有效性、蛋白尿作为肾毒性组成部分的相关性，以及我们目前无法可靠地预测或预防许多肾毒性事件。
