Cancer Treatment and Kidney Damage (Nephrotoxicity)

Your kidneys have important functions in your body. You have 2 kidneys. They are located just below the rib cage, 1 on each side of your spine. They clean all your blood and get rid of waste, which exits your body as pee. And they maintain a healthy balance of water, salts, and minerals. Your kidneys also make hormones that help control your blood pressure, make red blood cells, and keep your bones strong and healthy.

Some cancer treatments can hurt your kidneys. This is called nephrotoxicity. If your kidneys are damaged, they are less able to remove pee and other waste from your body. And they can't function correctly. Kidney damage may be short-term (temporary) or lifelong (permanent).

What cancer treatments cause kidney damage?

Chemotherapy (chemo). Not all chemo will hurt your kidneys. But some types of chemo can cause kidney damage because your kidneys help remove chemo medicines from your blood. Some chemo medicines that can harm your kidneys include:

• Cisplatin

• Carboplatin

• Ifosfamide

• Methotrexate

Radiation therapy. Radiation that is aimed at the kidneys or belly (abdomen) can cause kidney damage.

Stem cell transplant. Before you get a stem cell transplant, you may receive high doses of chemo or radiation. These can both damage your kidneys.

Immunotherapy. Some immunotherapy medicines called immune checkpoint inhibitors may cause kidney damage.

You are also more likely to have kidney damage during cancer treatment if you:

• Had a kidney or your bladder removed

• Have kidney cancer

• Had chemo as a child

• Have diabetes or high blood pressure

• Have urinary tract problems, such as chronic urinary tract infections

Symptoms of kidney damage

Symptoms of kidney damage may include:

• Swelling in your hands, ankles, feet, or other parts of the body

• High blood pressure

• Shortness of breath

• Not making much pee

• Pee looks foamy with a lot of bubbles

• Blood in your pee

• Feeling tired

• Taste of metal in the mouth or bad breath

• Itchy skin

• Nausea or vomiting

• Headache

• Muscle cramps

• Lack of appetite

If you have any of these symptoms, tell your healthcare provider right away.

How is kidney damage diagnosed?

Your cancer care team will check your kidneys before you start cancer treatment. You may also have tests during your treatment. They may look for kidney problems with:

• A physical exam

• Urinalysis (testing your pee sample)

• Blood tests such as blood urea nitrogen (BUN), creatinine tests, and glomerular filtration rate (eGFR)

• Imaging tests, such as an ultrasound, CT scan, or MRI

Preventing and treating kidney damage

Your healthcare providers can help you prevent kidney damage. They might suggest:

• IV (intravenous) fluids to clean your system

• Drinking plenty of fluids. Ask your provider how much you should drink per day.

• Regular checks of fluid and electrolyte levels in your blood

• Urine and blood tests to check your kidney function

• Medicines to protect your kidneys before certain cancer treatments

• Lowering your medicine dose or stopping a certain cancer treatment to prevent damage

Remember, kidney damage can be managed and treated. Talk with your provider if you have any concerns.