Kidney Health

The kidneys are vital organs that filter waste products from the blood, control blood pressure, and stimulate red blood cell production. Treatment for children’s cancer can sometimes damage the kidneys. Some kidney problems occur during therapy and persist, while others can begin years after completion of therapy.

Treatments Which Can Cause Kidney Problems

• Radiation therapy involving the bladder or kidneys
• Chemotherapy agents such as cisplatin, carboplatin, methotrexate and ifosfamide
• Antibiotics used to treat bacterial and fungal infections, such as tobramycin, gentamicin and amphotericin
• Medications used to treat graft-versus-host disease, such as cyclosporine and FK-506 (tacrolimus)
• Nephrectomy or Cystectomy which is surgical removal of the kidney or bladder

Follow Up Recommendations

Survivors who have received any of the above treatments should have yearly check-ups that include tests for kidney function and blood pressure. These may include urine and blood tests to look at kidney function and measure salts and minerals. Sometimes specialized X-rays are needed to better study kidney function. Healthcare providers may refer patients to a nephrologist or urologist (kidney or bladder specialist) for additional evaluation.

Steps to Keeping Kidneys Healthy

• Drink plenty of water.
• Call a healthcare provider immediately if there are symptoms of a urinary tract infection.
• Use non-steroidal anti-inflammatory drugs with caution. These include pain or fever medicines that contain aspirin, ibuprofen, acetaminophen or naproxen. If long-term medications are needed for pain management, discuss the alternatives with a healthcare provider and choose medications that are not harmful to the kidneys.
• Have a check-up at least once a year including the tests recommended based on the cancer treatment received.

Summary of recommendations for follow-up

Treatment	Recommended Follow-up	How Often
Ifosfamide Cisplatin Carboplatin	Medical check-up including blood pressure check	Yearly
	Blood tests to check kidney function blood urea nitrogent (BUN)	Yearly
	Urinalysis	Yearly
	Blood tests for electrolytes (blood salts and minerals)	First long term follow-up visit*, then every five years
	Kidney function test (creatinine clearance or GFR)	First long-term follow-up visit*, repeated periodically if problems are detected
Radiation involving the kidneys Cystectomy	Medical check-up including blood pressure check	Yearly
	Blood tests to check kidney function (BUN and creatinine)	Yearly
	Urinalysis	Yearly
	Blood tests for electrolytes (blood salts and minerals) and kidney function test (creatinine clearance or GFR)	If high blood pressure, protein in the urine, or abnormal BUN or creatinine. Repeat periodically if problems detected.
Cystectomy (also refer to above recommendations)	Urine culture	Yearly
	Check up by urologist	Yearly
Methotrexate	Medical check-up including blood pressure check	Yearly
	Blood tests to check kidney function (BUN and creatinine)	First long-term follow-up visit*
	Urinalysis	First long-term follow-up visit*
	Blood tests for electrolytes (blood salts and minerals) and kidney function test (creatinine clearance or GFR)	If high blood pressure, protein in the urine or abnormal BUN or creatinine. Repeat periodically if problems detected.

*First long-term follow-up visit should be at least 2 years after completing cancer therapy

For Patients Who Had a Kidney Removed During Cancer Treatment

Treatment for children’s cancer sometimes requires removal of one kidney (nephrectomy). Although patients can live a healthy life with only one kidney, it is important that they take steps to protect the remaining kidney in order to keep it as healthy as possible.

Recommended Follow Up

• Have a medical check-up at least yearly. This should include a blood pressure check, blood tests for kidney function (BUN, creatinine), and a urinalysis.
• High blood pressure or abnormal BUN, creatinine, or urinalysis results may require an additional blood test for electrolytes (blood salts and minerals) and a creatinine clearance test or GFR scan. The creatinine clearance test is a timed urine collection. The GFR scan is a special X-ray that measures kidney function using a small amount of radioactive material injected through a vein. If any problems are detected, these tests should be repeated periodically to monitor kidney function.
• Patients with high blood pressure, protein in the urine, or other signs of worsening kidney problems should have an evaluation by a nephrologist (kidney specialist).