VIEWS: 29 PAGES: 2 CATEGORY: Medicine POSTED ON: 6/26/2010
A global leader in serving libraries of all types, ProQuest LLC (“ProQuest”) supports the breadth of the information community with innovative discovery solutions that power the business of books and the best in research experience. More than a content provider or aggregator, ProQuest is an information partner, creating indispensable research solutions that connect people and information. Through innovative, user-centered discovery technology, ProQuest offers billions of pages of global content that includes historical newspapers, dissertations, and uniquely relevant resources for researchers of any age and sophistication—including content not likely to be digitized by others.
Nephrotoxicity_1209.qxp 11/24/09 12:14 PM Page 1 www.renalandurologynews.com DECEMBER 2009 Renal & Urology News 11 Avoiding Nephrotoxicity from Chemo Nephrologist offers advice related to the use of cisplatin, gemcitabine, and other agents BY ROSEMARY FREI, MSc toxicity, including exploring drugs of thrombotic microangiopathy, acute TORONTO — Clinicians can take that inhibit uptake of cisplatin by kidney injury (AKI), and chronic steps to prevent nephrotoxicity from the renal tubules or that stop the kidney disease. chemotherapy agents, according to apoptotic effect of cisplatin on “When this drug started to be used a researcher who spoke here at these cells. at the Princess Margaret Hospital [in the Prevention in Renal Disease 8th “All of these studies show some Toronto], where I practice, all of Annual Conference. reduction of nephrotoxicity, but no my colleagues were seeing a lot of Cisplatin is among the drugs dis- single agent or combination of agents patients with quite severe hyperten- cussed by Robert Richardson, MD, has been able to entirely reduce sion, many with significant protein- Professor of Nephrology at the nephrotoxicity,” he said. “I wouldn’t uria and in some cases nephrotic University of Toronto. The medica- be surprised, though, if in the next proteinuria among those receiving tion, which is effective for a wide few years there are agents or combi- bevacizumab,” he related. “But I have variety of solid tumors, frequently nations of agents that may selectively the impression that we’re not seeing results in nephrotoxicity. eliminate nephrotoxicity.” as many of these side effects now that SHUTTERSTOCK “About a third of patients in all Even when a therapeutic bullet is the drug is better understood.” studies involving cisplatin develop found that stops nephrotoxicity, there In addition, Dr. Richardson in- nephrotoxicity, mainly manifested by will always be residual concerns about formed listeners that ifosfamide pro- an elevated serum creatinine,” he said. concomitant reduction of the effec- duces subtle tubular dysfunction in “This typically occurs about 10 days tiveness of cisplatin, Dr. Richardson agent is not that of an endothelial up to 90% of patients, but it is usual- after administration of the drug. It is noted. Hence, researchers will have antagonist.” The effects are usually ly reversible and can be prevented also usually non-oliguric, so the pa- to produce data showing the anti- reversible when the medication is altogether by limiting the drug’s dose tient is unaware of this.” nephrotoxicity agents do not affect stopped, he said. Clinicians should to less than 84 g/m2. Moreover, he The most effective ways to address the tumor-remission rates with cis- assess patients after each course of said AKI from high-dose methotrex- this nephrotoxicity include reducing platin before clinicians or regulators gemcitabine for any signs of nephro- ate affects about 2% of patients. the cisplatin dose or switching to will take notice, he said. toxicity such as a decrease in hemo- Dr. Richardson recommends prevent- the cisplatin analogue carboplatin, Dr. Richardson also discussed gem- globin, platelets or glomerular filtra- ing it by using alkaline diuresis begin- Dr. Richardson said. Saline volume citabine, which he said is not directly tion rate, and for an increase in BP or ning 12 hours before the first infusion expansion during drug administration nephrotoxic but causes thrombotic the occurrence of dyspnea or central and continuing for 12 hours after the is an alternate strategy; it reduces microangiopathy in up to 1.4% of nervous system changes. infusion. For patients who develop nephrotoxicity in about one-third of patients with solid tumors. “It’s a sort Dr. Richardson also observed that AKI after high-dose methotrexate individuals, Dr. Richardson note
Pages to are hidden for
"Avoiding Nephrotoxicity from Chemo"Please download to view full document