Nephrotoxicity of Cancer Treatment in Children

Roderick Skinner


Pediatr Health. 2010;4(5):519-538. 

In This Article

Importance of Nephrotoxicity

The importance of nephrotoxicity lies in its potential frequency, severity and unpredictability. A recent study of 4684 adults (mean age 58 years) undergoing treatment for cancer in 15 French centers (the Renal Insufficiency and Anticancer Medications [IRMA] study) found that 50–60% had biochemical evidence of impaired glomerular function.[10] Several factors are likely to explain this higher prevalence of renal dysfunction compared with that described in young adult survivors of childhood malignancy in the CCSS,[9] including the timing of evaluation of renal function (i.e., during treatment in the IRMA study, rather than >5 years later as in the CCSS study) and increased vulnerability to nephrotoxicity in older patients due to the expected decline in renal function with increasing age.[11] Although no direct comparison is available, it appears unlikely that the type and doses of agents used in chemotherapy protocols in adults are intrinsically more nephrotoxic than those used in children.

However, even if renal toxicity is less common in children, it has the potential to be very severe with profound long-term consequences. Recent data from the UK Renal Registry Report indicated that 1.9% of cases of established renal failure in children were due to malignancy (whereas malignancy only occurs in ~0.17% of children) and 0.8% were caused by drug nephrotoxicity.[12] Furthermore, another CCSS study of over 10,000 survivors of childhood cancer reported that 0.5% had developed renal failure or were requiring dialysis, with a RR to siblings of 8.9 (95% CI: 2.2–36.6).[5] In addition, although severe renal toxicity is often attributable to well-known risk factors (e.g., treatment with recognized nephrotoxins), it is not always predictable and may occasionally affect patients who have not received any recognized nephrotoxins and who do not have any other apparent risk factors [Hjorth L, Unpublished Data].