Kidney Disease in Childhood Cancer Survivors

Chronic glomerular and tubular nephrotoxicity has been reported in up to 50% and 25%, respectively, of children and adolescents treated with ifosfamide and up to 60% and 30% of those given cisplatin. Up to 35% of children have proteinuria and microalbuminuria, implying chronic glomerular damage, after unilateral nephrectomy for a renal tumour. We are still learning about nephrotoxicity due to the new targeted anticancer drugs. Overall, childhood cancer survivors have nine times greater risk of developing renal failure than their siblings. Such chronic nephrotoxicity may have multiple causes including certain chemotherapy agents (especially ifosfamide and platinum agents), radiotherapy to the kidneys, renal surgery, supportive care drugs and tumour-related factors. These cause a wide range of chronic glomerular and tubular toxicity, often with potentially severe clinical sequelae. Although many risk factors for developing nephrotoxicity, mostly patient and treatment-related, have been described, they do not predict all children who subsequently develop chronic renal damage. This suggests that other factors may be involved, such as genetic polymorphisms influencing drug metabolism. Further research is necessary to enable prediction or early detection of nephrotoxicity, whilst greater understanding of the pathogenesis of nephrotoxicity is needed to allow us to prevent its occurrence in the future.