Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA.
Division of Nephrology, Massachusetts General Hospital, Boston, MA.
Adv Chronic Kidney Dis. 2021 Sep;28(5):402-414.e1. doi: 10.1053/j.ackd.2021.08.001.
Conventional chemotherapies remain the mainstay of treatment for many malignancies. Kidney complications of these therapies are not infrequent and may have serious implications for future kidney function, cancer treatment options, eligibility for clinical trials, and overall survival. Kidney adverse effects may include acute kidney injury (via tubular injury, tubulointerstitial nephritis, glomerular disease and thrombotic microangiopathy), long-term kidney function loss and CKD, and electrolyte disturbances. In this review, we summarize the kidney complications of conventional forms of chemotherapy and, where possible, provide estimates of incidence, and identify risk factors and strategies for kidney risk mitigation. In addition, we provide recommendations regarding kidney dose modifications, recognizing that these adjustments may be limited by available supporting pharmacokinetic and clinical outcomes data. We discuss management strategies for kidney adverse effects associated with these therapies with drug-specific recommendations. We focus on frequently used anticancer agents with established kidney complications, including platinum-based chemotherapies (cisplatin, carboplatin, oxaliplatin), cyclophosphamide, gemcitabine, ifosfamide, methotrexate and pemetrexed, among others.
传统化疗仍然是许多恶性肿瘤的主要治疗方法。这些治疗方法的肾脏并发症并不少见，可能对未来的肾功能、癌症治疗选择、临床试验资格和整体生存产生严重影响。肾脏不良反应可能包括急性肾损伤（通过肾小管损伤、肾小管间质性肾炎、肾小球疾病和血栓性微血管病）、长期肾功能丧失和 CKD 以及电解质紊乱。在这篇综述中，我们总结了传统形式化疗的肾脏并发症，并在可能的情况下提供了发病率的估计，并确定了肾脏风险缓解的危险因素和策略。此外，我们还就肾脏剂量调整提出了建议，认识到这些调整可能受到现有支持药代动力学和临床结果数据的限制。我们讨论了与这些疗法相关的肾脏不良反应的管理策略，并提供了具体的药物建议。我们重点关注具有明确肾脏并发症的常用抗癌药物，包括铂类化疗药物（顺铂、卡铂、奥沙利铂）、环磷酰胺、吉西他滨、异环磷酰胺、甲氨蝶呤和培美曲塞等。
