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
| Â | 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 |