Nephrotoxicity of Cancer Treatment in Children

Roderick Skinner


Pediatr Health. 2010;4(5):519-538. 

In This Article

Hemopoietic Stem Cell Transplantation

Renal toxicity associated with HSCT is often multifactorial, and the clinical presentation may be complicated further by contributions from prior treatment for the underlying condition, especially in children who have previously received nephrotoxic chemotherapy for solid tumors. The conditioning regimen for HSCT may include high doses of potentially nephrotoxic chemotherapy (e.g., carboplatin and melphalan), and/or TBI. Hypovolemia or compromised renal perfusion due to serious early transplant-related complications, including hemorrhage, severe sepsis or hepatic veno-occlusive disease, may cause prerenal failure, which may not be fully reversible. The frequent and often prolonged use of nephrotoxic antibiotics (e.g., aminoglycosides) and immunosuppressive treatment with ciclosporin A or tacrolimus may both potentiate and perpetuate renal impairment. It is, therefore, not surprising that chronic renal damage is frequent after HSCT, and has been reported as occurring in up to nearly 50% of children.[166] Glomerular toxicity is usually predominant and, although TBI is often assumed to be primarily responsible in children undergoing allogeneic HSCT for leukemia, it is clear that other causative factors are also involved.[167,168] By contrast, tubular impairment is probably mainly due to conditioning chemotherapy, often in the context of autologous HSCT for heavily pretreated children with relapsed or refractory solid tumors.[166]