Cisplatin treatment often produces extensive gastrointestinal side effects, which might lead to more magnesium depletion through anorexia and diarrhea. Renal and electrolyte disturbances associated with cisplatin. Nephrotoxicity with cisplatin and antihypertensive. Cisplatin nephrotoxicity aggravated by cardiovascular disease and diabetes in lung cancer patients c. Nephrotoxicity of cancer treatment in children medscape. Evidence for interventions to prevent nephrotoxicity. Cisplatin nephrotoxicity nephrotoxicity was reported in the initial clinical trials of cisplatin chemotherapy. Cisplatin induced oxidative stress in the kidney may be prevented by natural. Cisplatin is a cancer medication that interferes with the growth of cancer cells and slows their growth and spread in the body. Numerous compounds have been studied to prevent cisplatin nephrotoxicity but only amifostine is us food and drug administration fdaapprovedfor protectionagainstcumulative. Cisplatin is an anticancer antineoplastic or cytotoxic chemotherapy drug. To minimize cisplatin resistance, combinatorial therapies were developed and have proven more effective to defeat cancers.
The serum creatinine, blood urea nitrogen bun, creatinine clearance, and magnesium, sodium. Objective to determine whether appropriate dose adjustment is made in patients with renal impairment using the cockcroftgault cg or the abbreviated modification of diet in renal disease amdrd formulas to estimate the glomerular filtration rate gfr. The nephrotoxic effect of cisplatin is cumulative and dosedependent and often necessitates dose reduction or withdrawal. Appropriate management of therapy and complications is. The laboratory observation that forced hydration and diuresis may prevent. The purpose of our study was to propose an outpatient highdose cisplatin protocol aimed at preventing nephrotoxicity and to analyze the results of its utilization in patients with scchn treated with concurrent radiother. Thrombotic microangiopathy, hypomagnesaemia, salt wasting, fanconilike syndrome, and anemia are other clinical manifestation of cisplatin. Aminoglycosides preferentially affect the proximal tubular cells. I was recently consulted on an oncology patient with suspected cisplatin nephrotoxicity. The incidence of nephrotoxicity after repeated infusion of cisplatin was not affected by the infusion rate of cisplatin.
Implication for health policypracticeresearchmedical education. Recent evidence has demonstrated that patients with chronic kidney disease ckd have an increased risk of developing acute kidney injury aki. Some patient related risk factors for druginduced nephrotoxicity are age older than 60 years, underlying renal insufficiency eg, gfr of less than 60 mlminute1. The aim of this study was to determine the appropriate therapeutic steps when nephrotoxicity occurs due to cisplatin combination chemotherapy. The risk for acute renal failure increases with the presence of each additional risk factor. Cisplatin is a major antineo plastic drug for the treatment of solid tumors, but it has dosedependent renal toxicity. Cisplatin dosing, indications, interactions, adverse effects. Nephrotoxicity induced by cancer chemotherapy with special. Cisplatin, cardiac toxicity, ischemia, delayed toxicity. The significant protective effect of zinc sulfate on cisplatin induced nephrotoxicity may be through its antioxidant and antiinflammatory action. The vulnerability of the kidney to cisplatin is almost certainly related to its primary role in. Evidence for nephrotoxicity prevention with cisplatin. The dose depends on multiple factors, including whether the tumor is nonsmallcell lung cancer nsclc or smallcell lung cancer sclc.
Chemotherapy and kidney injury american society of. To evaluate cisplatininduced nephrotoxicity in outpatients receiving chemotherapy with cisplatin alone or in combination with other agents using a short hydration method. Despite ototoxicity being a prevalent consequence of cisplatin chemotherapy, little guidance exists on interventions to prevent this permanent and progressive adverse event. Pathophysiology of cisplatininduced acute kidney injury. Cisplatin and other platinum derivatives are the most widely used chemotherapeutic agents to treat solid tumors including ovarian, head and neck, and testicular germ cell tumors. Platinol cisplatin for injection side effects, images. Molecular mechanisms authors luis alberto batista peres1 ademar dantas da cunha junior2 1 state university of west parana unioeste, assis gurgacz college, cascavel, brazil.
Nephrotoxicity evaluation in outpatients treated with. In 425 patients treated with cisplatin, we assessed the effect of pretreatment factors and treatment conditions on the rise in serum creatinine with the first course of cisplatin, on the maximum rise in serum creatinine over the entire course of the cisplatin therapy, and on residual nephrotoxicity after the last. Indianapolis, in, usa according to the manufacturers instruction. A known complication of cisplatin administration is acute kidney injury aki. Cisplatin is a potent and valuable chemotherapy agent used to treat a broad spectrum of malignancies. Cisplatin produces cumulative nephrotoxicity which is potentiated by aminoglycoside antibiotics. The most significant clinical manifestation of cisplatin nephrotoxicity is acute and chronic impairment of renal function, which are associated with major morbidity and mortality among these patients. Although efficacy is limited by cisplatin induced nephrotoxicity cin, little is known about the risk factors for this complication. Cisplatin dosing, indications, interactions, adverse. Mar 06, 2018 what is cisplatin platinol, platinol restricted access, platinolaq.
Commonly reported side effects of cisplatin include. The pathophysiological phenomena of cisplatininduced kidney injury include. Cisplatin is a coordinate metal complex with significant antineoplastic activity and various adverse effects, including acute and chronic renal insufficiency and renal magnesium wasting. The method used in our study shows minimal changes in renal functions. Reactive nitrogen species have also been studied in cisplatin induced nephrotoxicity.
We retrospectively evaluated potential risk factors for cisplatininduced nephrotoxicity as well as the potential impact of intravenous magnesium supplementation on such toxicity. These agents are freely filtered by the glomeruli and quickly taken up by the proximal tubular epithelial cells, where they are incorporated into lysosomes after first interacting with phospholipids on the brush border membranes. Cisplatin nephrotoxicity aggravated by cardiovascular. Cisplatin is the generic name for the trade name drug platinol and platinolaq. Background nephrotoxicity remains a problem for patients who receive cisplatin chemotherapy. The renal content of peroxynitrite and nitric oxide is increased in cisplatintreated rats.
Prevention of cisplatininduced ototoxicity in children. Science behind cisplatininduced nephrotoxicity in humans. Prediction of nephrotoxicity induced by cisplatin combination. See chemotherapy nephrotoxicity and dose modification in patients with renal insufficiency. Association of cisplatin nephrotoxicity with patient. Retrospective analysis of cisplatin nephrotoxicity in patien. Cisplatin, nephrotoxicity, zinc sulfate, oxidative stress, inflammation.
All the demographic details such as name, sex, age, occupation, education. Tell your nurse if you have any redness, burning, pain, swelling, blisters, skin sores, or leaking of fluid where the drug is going into your body. Numerous mechanisms of cisplatin resistance were described including changes in cellular uptake, drug efflux, increased detoxification, inhibition of apoptosis and increased dna repair. Risk factors associated with cisplatininduced nephrotoxicity. Nephrotoxicity of cisplatin combination chemotherapy in. This article aims to identify best practices in supportive therapy for patients. Cisplatininduced kidney dysfunction and perspectives on. Cisplatin remains the pivotal chemotherapy in squamous cell carcinoma of the head and neck scchn, with nephrotoxicity considered the doselimiting toxicity. Platinol cisplatin for injection, usp should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Renal toxicity typically begins during the second week after a dose of cisplatin for injection.
Jan 17, 2014 background nephrotoxicity is the doselimiting side effect of cisplatin justifying the assessment of renal function for dose adjustment. However, side effects in normal tissues and organs, notably nephrotoxicity in the kidneys, limit the use of cisplatin and related platinumbased therapeutics. In some cases, health care professionals may use the trade name platinol and platinolaq, or other names such as cddp, when referring to the generic drug name cisplatin. What is cisplatin platinol, platinol restricted access, platinolaq. Hypomagnesemia and renal magnesium wasting in patients receiving. The features of cisplatininduced peripheral neuropathy were described extensively in the editorial entitled cisplalin neurotoxicity jan. Mar 15, 2016 nephrotoxicity is the major side effect that limits the dose of cisplatin that can be safely administered, and it is a clinical problem in cancer patients who received cisplatin combination chemotherapy. Arecent study showed that hydration with saline alone or saline with furosemide appear to be associated with less cisplatin nephrotoxicity than saline with mannitol, we decided toconduct astudy to evaluate the nephrotoxicity of cisplatin incancer patients using different protocols of. Nephrotoxicity of cisplatin combination chemotherapy in thoracic malignancy patients with ckd risk factors ko sato1. The use of cisplatin in patients with preexisting renal dysfunction and the renal effects of the platinum analogs, carboplatin and oxaliplatin, are discussed elsewhere. Recommendations issued for preventing druginduced nephrotoxicity. The patient had hematuria with dysmorphic red blood cells on microscopy, and i wondered whether this could be a manifestation of cisplatin toxicity. Cisplatin dose adjustment in patients with renal impairment.
Research over the past 10 years has uncovered many of the cellular mechanisms which underlie cisplatin induced. Approximately, 20% of patients treated with cisplatin suffer from nephrotoxicity such as. Nephrotoxicity renal toxicity managing side effects. Some patient related risk factors for druginduced nephrotoxicity are age older than 60 years, underlying renal insuf ficiency e.
Chemotherapy, radiotherapy, and surgery are the most common modalities used to treat a patient with cancer. When kidney damage occurs, you are unable to rid your body of excess urine, and wastes. Find information on furosemide lasix in daviss drug guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, administration, and more. Oct 26, 2010 cisplatin is a widely used and highly effective cancer chemotherapeutic agent. A 58yearold man with metastatic bladder cancer was treated with cisplatin, 70 mgm 2 body surface area, intravenously, after hydration with normal saline, 0. Cisplatin and its side effects on the kidney an estimated 20% of patients receiving highdose cisplatin have severe renal dysfunction and approximately one third of patients experience kidney injury just days following initial treatment1. Nephrotoxicity may occur in as many as 50% to 75% of patients receiving the drug, and is apparently due to renal tubular injury. One of the limiting side effects of cisplatin use is nephrotoxicity. See below for a comprehensive list of adverse effects. Research article effect of zinc sulfate in protection against. The renal content of peroxynitrite and nitric oxide is increased in cisplatin treated rats. Cisdichlorodiammine platinum ii, or cisplatin, has emerged as a principal chemotherapeutic agent in the treatment of otherwise resistant solid tumors and is currently among the most widely used agents in the chemotherapy of cancer. To assess factors that affect cisplatin nephrotoxicity. To effectively monitor nephrotoxicity, renal parameters and electrolyte levels should be measured before and after each cisplatin based chemotherapy cycle.
The use of cisplatin in patients with preexisting kidney dysfunction and the renal effects of the platinum analogs, carboplatin and oxaliplatin, are. Pdf prevention of cisplatin nephrotoxicity researchgate. The vulnerability of the kidney to cisplatin is almost certainly related to its primary role in the excretion. The role of oxidantantioxidant systems in chronic nephrotoxicity is uncertain. Cisplatin is a widely used and highly effective cancer chemotherapeutic agent. To develop a clinical practice guideline for the prevention of cisplatininduced ototoxicity in children and adolescents with cancer, we convened an international, multidisciplinary panel of experts and patient advocates. Prevention of cisplatininduced ototoxicity in children and. Recent research has shed significant new lights on the mechanism of cisplatin nephrotoxicity, especially on the signaling pathways leading to tubular cell death. Nephrotoxicity was reported in the initial clinical trials of cisplatin chemotherapy. Cisplatin and magnesium affect the same sodium and water channels in the outer medulla. Cisplatin is one of the most widely used and most potent chemotherapy drugs. Ageing lung cancer patients may be at increased risk of cisplatin cp.
This medicine may cause tissue damage if the drug leaks from the vein. Both proximal and distal tubules are affected, and in patients with aki, there is usually acute tubular necrosis. More investigations are required to evaluate this method with higher doses of cisplatin. Background nephrotoxicity is the doselimiting side effect of cisplatin justifying the assessment of renal function for dose adjustment. Cisplatin is used together with other medications to treat bladder cancer, testicular cancer, or ovarian cancer. Evidence for nephrotoxicity prevention with cisplatin therapy.
The vulnerability of the kidney to cisplatin is almost certainly related to its primary role in the excretion of cisplatin. Research article open access nephrotoxicity of cisplatin combination chemotherapy in thoracic malignancy patients with ckd risk factors ko sato1, satoshi watanabe2, aya ohtsubo1, satoshi shoji1, daisuke ishikawa1, tomohiro tanaka1. Anaesthetic implications of chemotherapy bja education. The chief limit to its greater efficacy is its nephrotoxicity, which has made it necessary both to lower its dosage and actively hydrate patients to reduce it. This article aims to identify best practices in supportive therapy for patients receiving cisplatin therapy. We collected data from 18 patients undergoing cisplatin chemotherapy including. Cisplatin nephrotoxicity american journal of kidney diseases. To develop a clinical practice guideline for the prevention of cisplatin induced ototoxicity in children and adolescents with cancer, we convened an international, multidisciplinary panel of experts and patient advocates. Cancer hospital of cascaveluniao oeste center of cancer studies uopeccan. Cisplatin has been used as a chemotherapeutic agent to treat many different cancers. Reactive nitrogen species have also been studied in cisplatininduced nephrotoxicity. Many established chemotherapy drugs are antiproliferative agents, targeting rapidly dividing cancer cells but also damaging nonmalignant dividing cells, leading to toxicity.
Intravenous administration of mannitol an osmotic diureticprevents over retention of. Renal insufficiency can be prevented by hydration and forced disuresis. A wellknown side effect of cisplatin is nephrotoxicity, which is the primary doselimiting toxicity. Some patientrelated risk factors for druginduced nephrotoxicity are age older than 60 years, underlying renal insuf ficiency e. Fortynine patients enrolled in the study were monitored during 3 cycles of chemotherapy. Research over the past 10 years has uncovered many of the cellular mechanisms which underlie cisplatininduced. Cisplatin for injection can cause doserelated nephrotoxicity, including acute renal failure that becomes more prolonged and severe with repeated courses of the drug. Platinol cisplatin for injection side effects, images, uses. Nortier, early detection of acute cisplatin nephrotoxicity. Cisplatin induces magnesium depletion, and magnesium deficiency itself may enhance cisplatin nephrotoxicity. Nephrotoxicity is one of the most common kidney problems and occurs when your body is exposed to a drug or toxin that causes damage to your kidneys. Cisplatin nephrotoxicity is clearly doserelated and used to be considered dose limiting. Hydration in conjunction with appropriate diuresis can decrease the incidence of nephrotoxicity. Cisplatin for injection is a highly emetogenic antineoplastic agent.
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