Abstract
Acute kidney injury is a common complication of many medical procedures, including those used in cancer treatment. Both chemotherapy and immunotherapy may result in deterioration of kidney function, which may lead to an increase in mortality among patients with cancer. Antineoplastic agents can affect any element of the nephron, leading to the appearance of clinical symptoms such as proteinuria, hypertension, electrolyte disorders, glomerulonephritis, acute and chronic interstitial nephritis and acute kidney injury. The medical literature describing renal complications occurring during chemotherapeutic and immunotherapeutic treatment in neoplasms, such as colorectal cancer, non-small cell lung cancer and melanoma, was analysed. The immune system plays an important role in controlling the development of neoplasms and fighting them. Oncological treatment algorithms include immunotherapy as monotherapy, combined with chemotherapy or chemotherapy as monotherapy. In the treatment of the above-mentioned neoplasms immunotherapeutics are used, such as checkpoint inhibitors (CPI) (i.e., ipilimumab, pembrolizumab, nivolumab, atezolizumab), vascular endothelial growth factor (VEGF) inhibitors (i.e., bevacizumab, ramucirumab) and a variety of chemotherapeutic agents (irinotecan, capecitabine, oxaliplatin, gefitinib, erlotinib, gemcitabine, cisplatin, paclitaxel, carboplatin, doclitaxel, vinorelbine, topotecan, etoposide). In our article, we focused on the number and type of renal complications as well as on the time of their manifestation when using specific treatment regimens. Our analysis also includes case reports. We discussed treatment of immunological complications and adjustments of the dose of chemotherapeutic agents depending on the creatinine clearance. Analysing the data from the literature, when two immunotherapeutic agents are used together, the number of recorded renal complications increases. Bevacizumab and ramucirumab are the cause of the largest number of renal complications among the immunotherapeutic agents described above. Cisplatin is the best-described substance with the greatest nephrotoxic potential among the chemotherapeutic agents. Crucial for renal complications are also cancer stage, previous chemotherapy and other risk factors of AKI such as age, comorbidities and medications used. Due to the described complications during oncological treatment, including kidney damage, it seems necessary to elaborate standards of cooperation between oncologists and nephrologists both during and after treatment of a patient with cancer. Therefore, it is necessary to conduct further research and develop algorithms for management of a cancer patient, especially during such an intensive progress in oncology.
Highlights
The kidneys are key organs for the proper functioning of the body and for the maintenance of homoeostasis
The use of an antibody targeted at a VEGF ligand or vascular endothelial growth factor (VEGFR) will result in its binding and sequestration [11]
The study of a larger group of patients was conducted by Sandler et al Among 427 patients receiving carboplatin, paclitaxel and bevacizumab at a dose of 15 mg/kg, 13 (3%) developed proteinuria: 11 (2.6%) of the cases were classified as grade 3 complication and 2 (0.5%) as grade 4 complication
Summary
The kidneys are key organs for the proper functioning of the body and for the maintenance of homoeostasis Their role is, among other things, to remove endogenous metabolic products as well as to eliminate medicines and toxins. Kidney injury is a serious complication resulting both from the progression of the neoplastic disease itself and the method of treatment. Terminology Criteria for Adverse Events (from v3.0 to v5.0) and Common Toxicity Criteria (from v1.0 to v2.0), we described acute kidney injury, elevated creatinine and proteinuria according to corresponding grades. For the increase in creatinine levels, we used the following grades: grade 1 (>1–1.5 × baseline; >ULN (upper limit of normal)-1.5 × ULN), grade 2. The grading scale is as follows: grade 1 (creatinine level increase of >0.3 mg/dL; creatinine 1.5–2.0 × above baseline), grade 2 Renal complications that occur during chemotherapeutic and immunotherapeutic treatments of selected neoplasms, such as colorectal cancer, non-small cell lung carcinoma and melanoma, will be discussed
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