Verzicco Ignazio, Regolisti Giuseppe, Quaini Federico, Bocchi Pietro, Brusasco Irene, Ferrari Massimiliano, Passeri Giovanni, Cannone Valentina, Coghi Pietro, Fiaccadori Enrico, Vignali Alessandro, Volpi Riccardo, Cabassi Aderville
Unità di Ricerca Cardiorenale, Clinica e Terapia Medica, Dipartimento di Medicina e Chirurgia (DIMEC), University of Parma, Parma, Italy.
Unità di Ricerca sulla Insufficienza Renale Acuta e Cronica, Unità di Nefrologia, Dipartimento di Medicina e Chirurgia (DIMEC), University of Parma, Parma, Italy.
Front Oncol. 2020 May 19;10:779. doi: 10.3389/fonc.2020.00779. eCollection 2020.
The use of antineoplastic drugs has a central role in treatment of patients affected by cancer but is often associated with numerous electrolyte derangements which, in many cases, could represent life-threatening conditions. In fact, while several anti-cancer agents can interfere with kidney function leading to acute kidney injury, proteinuria, and hypertension, in many cases alterations of electrolyte tubular handling and water balance occur. This review summarizes the mechanisms underlying the disturbances of sodium, potassium, magnesium, calcium, and phosphate metabolism during anti-cancer treatment. Platinum compounds are associated with sodium, potassium, and magnesium derangements while alkylating agents and Vinca alkaloids with hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). Novel anti-neoplastic agents, such as targeted therapies (monoclonal antibodies, tyrosine kinase inhibitors, immunomodulators, mammalian target of rapamycin), can induce SIADH-related hyponatremia and, less frequently, urinary sodium loss. The blockade of epidermal growth factor receptor (EGFR) by anti-EGFR antibodies can result in clinically significant magnesium and potassium losses. Finally, the tumor lysis syndrome is associated with hyperphosphatemia, hypocalcemia and hyperkalemia, all of which represent serious complications of chemotherapy. Thus, clinicians should be aware of these side effects of antineoplastic drugs, in order to set out preventive measures and start appropriate treatments.
抗肿瘤药物的使用在癌症患者的治疗中起着核心作用，但常常与多种电解质紊乱相关，在许多情况下，这些紊乱可能代表危及生命的状况。事实上，虽然几种抗癌药物可干扰肾功能，导致急性肾损伤、蛋白尿和高血压，但在许多情况下，也会出现电解质肾小管处理和水平衡的改变。本综述总结了抗癌治疗期间钠、钾、镁、钙和磷代谢紊乱的潜在机制。铂类化合物与钠、钾和镁紊乱有关，而烷化剂和长春花生物碱则因抗利尿激素分泌不当综合征（SIADH）导致低钠血症。新型抗肿瘤药物，如靶向治疗药物（单克隆抗体、酪氨酸激酶抑制剂、免疫调节剂、雷帕霉素靶蛋白），可诱导与SIADH相关的低钠血症，较少见的是尿钠丢失。抗表皮生长因子受体（EGFR）抗体阻断EGFR可导致临床上显著的镁和钾丢失。最后，肿瘤溶解综合征与高磷血症、低钙血症和高钾血症相关，所有这些均代表化疗的严重并发症。因此，临床医生应了解抗肿瘤药物的这些副作用，以便制定预防措施并开始适当治疗。
