Information for Childhood Cancer Survivors. Kidney Problems

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1 Kidney problems Some chemotherapy drugs can affect the kidneys. The kidneys break down and remove many chemotherapy drugs from the body. When chemotherapy drugs get broken down, they may make products that damage the cells in the kidneys, ureters and bladder. The potential for kidney damage varies with the type of chemotherapy drug. A treatment that is toxic to the kidney is called nephrotoxic. How the kidneys work The kidneys are 2 bean-shaped organs, each about the size of an adult fist. They are located below the ribcage near the middle of the back. The kidneys filter waste products from the blood, control blood pressure and stimulate red blood cell production. Filtering occurs in tiny units inside the kidneys, known as nephrons. Each kidney has approximately 1 million nephrons. After the nephrons filter the blood, the excess water and waste products become urine. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder then stores the urine until it is full. Then the urine is emptied from the body through the urethra. Kidney function is measured in percentages. Two normal kidneys account for 100% kidney function. A single kidney is about 50%. A person can lead a normal life with one kidney as long as it remains healthy. If kidney function drops below 50%, there is a risk of health problems. Dialysis (artificial removal of waste products and excess water from the blood) or a kidney transplant may be necessary if kidney function falls to 15% or less. Types of kidney problems Kidney problems that can occur after treatment for childhood cancer may include: renal tubular acidosis 1 4-Jul-2012

2 Information for Childhood Cancer Survivors This condition occurs when the kidneys do not properly remove acids from the bloodstream. Fanconi syndrome This disorder occurs when the kidneys do not properly absorb certain substances, such as electrolytes and nutrients, into the bloodstream. kidney failure high blood pressure Who is at risk Kidney problems may be caused by treatment for Wilms tumour and other childhood cancers, such as leukemia. The following may increase the risk of kidney problems: removal of a kidney (nephrectomy) having cancer in both kidneys age at treatment the younger the child, the greater the risk having a genetic syndrome that increases the risk of kidney problems, such as Denys-Drash syndrome chemotherapy with: cisplatin (Platinol AQ) carboplatin (Paraplatin, Paraplatin AQ) ifosfamide (Ifex) methotrexate carmustine (BiCNU, BCNU) lomustine (CeeNU, CCNU) radiation therapy to the kidney or areas near the kidney certain antibiotics and antifungal drugs certain medications used to treat graft-versus-host disease after stem cell transplant prior medical conditions that may affect kidneys, such as diabetes and high blood pressure history of urinary tract problems removal of the bladder (cystectomy) Signs and symptoms Some signs and symptoms that may suggest kidney damage and impaired kidney function include: swelling or puffiness of the hands, feet or other areas of the body (edema) 2 4-Jul-2012

3 high blood pressure (hypertension) fatigue anemia increased weight unbalanced fluid intake and output decreased urine rapid heart rate (tachycardia) rapid breathing Diagnosis Before chemotherapy is started, kidney function may be checked to make sure that there are no major problems. This may also be done during treatments to ensure that no changes have occurred. Tests may include: blood pressure urinalysis blood tests blood urea nitrogen (BUN) creatinine electrolytes Prevention and management The healthcare team takes measures to help prevent and manage kidney problems that may occur because of chemotherapy. Tell the doctor or healthcare team about any symptoms, such as sudden swelling or puffiness, and any changes to the amount of urination. It is important for the child to be well hydrated before and after chemotherapy, especially when certain chemotherapy drugs are used. Extra fluids may be given intravenously. This helps prevent kidney problems by flushing breakdown products out of the kidneys. Certain medications may be given to protect against damage when nephrotoxic chemotherapy is given. sodium bicarbonate amifostine (Ethyol) Diuretic therapy may be used to increase excretion. 3 4-Jul-2012

4 During treatment, the healthcare team will check fluid and electrolyte levels in blood or urine samples to see how well the kidneys are working. If kidney damage occurs, the dose of chemotherapy drug is reduced or the drug may be stopped completely. If severe kidney damage occurs and causes the kidneys to fail, dialysis may be needed to clean waste products from the blood. Life after treatment Taking the following steps can help prevent kidney problems and help the person cope with symptoms: Be aware of signs and symptoms of dehydration. Drink plenty of fluids to ensure a regular flow of urine. Cut down on salt. Take the salt shaker off the table and replace it with herb seasonings or pepper. Eat less of foods that have a lot of salt in them (such as chips, prepared foods, luncheon meats or pickles). Raise legs if feet are swollen, and avoid wearing tight or constrictive clothing. Check with the doctor or pharmacist before taking any new medications. Use nonsteroidal anti-inflammatory drugs (NSAIDs) with caution. These include pain or fever medicines that contain acetylsalicylic acid (ASA, aspirin, salicylate), ibuprofen (Mortrin, Advil, Nuprin), acetaminophen (Tylenol, Atasol) or naproxen. Call the doctor or healthcare team if any symptoms develop. Follow-up All childhood cancer survivors need regular follow-up. Any childhood cancer survivor treated with nephrotoxic chemotherapy or radiation therapy to the kidney area should have a yearly physical examination. Follow-up tests may include: physical examination blood pressure urinalysis blood tests blood urea nitrogen (BUN) creatinine electrolytes 4 4-Jul-2012

5 It is important for childhood cancer survivors to inform their healthcare providers about their treatment history. The Canadian Cancer Society provides general information only. Talk to a qualified healthcare professional before making medical decisions. The Canadian Cancer Society cannot guarantee that this information is error-free or complete. Need more information? Contact the Canadian Cancer Society if you d like more information about this or any other cancer-related topic. We can also provide you with the references for this document. Call us toll-free at (TTY: ) or us at info@cis.cancer.ca. 5 4-Jul-2012

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