Table 2 Importance of renal biopsy in cancer patients

Prerenal failure

Weigh loss, dizziness, skin dryness, low blood pressure, tachycardia, oliguria.

No biopsy

All drugs associated with dehydration, vomiting or diarrhea

Obstructive renal failure

Pelvic cancer localization

Suspicion or demonstration of ureteral dilation

No ureteral stenting in presence of peritoneal carcinosis

Oliguria, anuria

Hypogastric pain or in the lumbar fossa

Hematuria with clots

No biopsy

All drugs inducing a lysis syndrome or renal stones

Glomerular disease

Hypertension, edema

Proteinuria composed mostly with albumin, hematuria without clots

Nephrotic syndrome (plasma albumin below 30 g/L and nephrotic range proteinuria)

Perform immediate renal biopsy

- Interferon:

podocytopathy inducing clinically minimal change disease, focal segmental glomerulosclerosis [22]

- Anti-VEGF agents:

hypertrophy of glomerular endothelial cells, widening of the subendothelial space [23, 24]

- Tyrosine kinase inhibitors:

Gefitinib: minimal changes [25, 26]

Sorafenib [27]

- Anthracyclines:

Doxorubicin: focal segmental glomerulosclerosis [28]

Tubular disease

Proteinuria composed mostly with low weight proteins

Leukocyturia

No hematuria

Perform delayed renal biopsy if

- If no resolution after 2 to 4 weeks

- If clinical and biological picture is not clearly in favor of tubular disease

- Antimetabolites:

Methotrexate: precipitation on renal tubules and tubule cells apoptosis [29]

Pemetrexed: renal tubular cells apoptosis

- Alkylating agents:

Platinum salts: renal tubular cells apoptosis [3, 18]

Ifosfamide: acute proximal tubular injury inducing Fanconi syndrome, diabetes insipidus [30]

- Hormone therapy:

Androgen deprivation therapy: acute tubular injury [31]

- Anti-EGFR agents:

Cetuximab: hypomagnesemia due to magnesium transport channel alteration in the loop of Henle [32]

- mTOR inhibitors:

Everolimus: antiproliferative effects and induction of tubular cells autophagy [33]

Interstitial disease

Cutaneous rash, liver enzymes increase, hypereosinophilia, urinary eosinophils

Essential and with no delay

- Acute interstitial disease:

bevacizumab [34, 35], sunitinib [36, 37, 38], ifosfamide [39, 40], carboplatin [41], gemcitabin [38], methotrexate [38], interferon [42], Bcg therapy [43,44,45]

- Chronic interstitial disease [24]:

ifosfamide, carboplatin, doxorubicin

Vascular disease

Presence of schizocytes, drop in platelet count, undetectable haptoglobin or low level in an inflammatory context

Cutaneous vasculitis

Perform biopsy if platelet level compatible

VEGF inhibitors:

bevacizumab [46, 47], sorafenib [48], gemcitabine [12, 13, 49, 50], sirolimus [51], afilbercept [52, 47]

Antitumor antibiotic:

mitomycin C [53]

Interferon [54]

Tyrosine kinase inhibitors:

Imatinib [55, 47]