Acute kidney injury associated with cancer therapies: A focus on conventional chemotherapies and targeted treatments

Advances in cancer therapies have allowed for improved cancer outcomes; however, with the benefits of novel treatments, clinicians must recognize associated side effects, including acute kidney injury (AKI). AKI and associated changes in kidney function are particularly consequential in patients with cancer, as these may lead to ineligibility for treatments, delays and dose reductions in therapy as well as exclusion from clinical trials. This in turn has a negative impact on cancer outcomes. In this review, we address anticancer drug-induced AKI, with specific focus on conventional cytotoxic chemotherapies and targeted therapies chemotherapies. We discuss frequently nephrotoxic chemotherapies, including: platinum-based agents (cisplatin, carboplatin, oxaliplatin); methotrexate and its derivative, pemetrexed; gemcitabine; and other systemic therapies frequently complicated by AKI. With respect to targeted therapies, we review both AKI and pseudo-AKI (i.e. serum creatinine elevation related to drug-mediated impairment of tubular creatinine secretion) from multiple classes, including: anaplastic lymphoma kinase (ALK) inhibitors; cyclin-dependent kinase-4/6 (CDK4/6) inhibitors poly-ADP ribose polymerase (PARP) inhibitors; vascular endothelial growth factor (VEGF) and multi-target tyrosine kinase inhibitors, among others. For each therapy, we review mechanisms of injury and associated renal lesions and preventive strategies, where available. Both oncology and nephrology clinicians must be aware of, promptly recognize, and appropriately manage AKI associated with cancer therapies to allow for optimal cancer outcomes.