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Table 1 Optimal monitoring and care of renal function during chemotherapy [20]

From: Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed

  Before treatment During treatment In case of renal impairment
Clinical Evaluation of renal risk:
- Familial renal history
- Personal renal history (renal stones, recurrent cystitis, renal surgery, chronic kidney disease, acute renal failure)
- Comorbidities associated with renal impairment (e.g. diabetes, hypertension)
- Combined therapy associated with increased renal risk (all nephrotoxic drugs, e.g. NSAIDS, lithium)
- Patient education (for ambulatory treatment):
-Home monitoring of weight and blood pressure
-In case of vomiting/diarrhea with a significant weight loss (5%), patients should call their center
-In case of vomiting/diarrhea with a significant weight loss (5%), diuretics and/or ACE inhibitors or ARBs should be adjusted/stopped for a few days (call the center)
- Estimation of the severity of side effects (vomiting, nausea, anorexia, fever)
- Quantification of dehydration (weight loss)
- Blood pressure control and screening for orthostatic hypotension
- Choose appropriate imaging strategy (prefer imaging with no contrast media whenever possible) and prior hydration
- Discuss hospitalization
- Evaluate hydration status (e.g. edema, blood pressure, thirst, skin dryness)
- Blood pressure
- Bleeding or hematomas, cutaneous vasculitis,
- Quantify urinary volume (oliguria)
- Estimate clinical need for dialysis (pulmonary edema, hyper-hydration)
- Preserve non-dominant arm venous network for potential need for arteriovenous fistula
- Avoid subclavicular intravenous catheterizations (high risk for proximal venous thrombosis/stenosis and loss of chance for arteriovenous access)
- Try avoiding urethral catheter (to decrease risk of urinary tract infection)
- Stop every unnecessary drug and/or adjust dosage
Laboratory - Best estimation of glomerular filtration rate (usually with sMDRD formula) or specific formula (such as Calvert’s formula for platinum prescription [21])
- Baseline hemoglobin, platelets, LDH and haptoglobin (allowing comparison with future abnormalities)
- Urine dipstick (leukocytes, hematuria, proteinuria, glycosuria) and protein- creatinine ratio and identification of the origin (tubular or glomerular)
- Best estimate glomerular filtration rate and compare to previous values (+ urea value)
- In case of poor creatinine value due to rapid changes in muscle mass or severe malnutrition, 24-h creatinine clearance gives appropriate results
- Hemoglobin, platelets, LDH, haptoglobin, schizocytes, albuminemia
- Urine dipstick for hematuria, proteinuria, leukocyturia
In most cases, perform before and 8 to 10 days after each chemotherapy session and every month.
Usually discuss next results and adjust strategy depending on latest results
- Estimate GFR and metabolic complications of GFR decrease in acute cases (hyperkalemia, acidosis, hyperphosphataemia, hyperphosphatemia, hypocalcemia, hypomagnesemia)
- Plasma hemoglobin (and iron stores)
- 24-h proteinuria and qualitative assessment of urinary proteins
- Urinary ions and urine- plasma ratio for sodium, urea, and fractional excretion of sodium.
- LDH, haptoglobin, schizocytes, albuminemia