Kidney Problems after Childhood Cancer Treatment

What are kidney late effects?

Some childhood cancer treatments and stem cell transplants can cause kidney problems later in life. These problems are called late effects.

Late effects are side effects of cancer or its treatment that appear months or years after cancer treatment has ended. Late effects can affect 1 or more areas in the body. Effects can be mild to severe. 

The kidneys are 2 organs located below the rib cage. They remove waste and extra liquid from blood. This process makes urine.

Fluid and waste products can build up in the blood if kidneys do not work correctly. This buildup can cause health problems. 

Treatments that can cause kidney problems

Treatments such as radiation, chemotherapy, other medicines, and surgery may cause kidney problems.

Radiation

Radiation to these places can cause kidney problems:

• Area around kidneys
• Belly
• Total body irradiation (sometimes used before a stem cell transplant (bone marrow transplant)  

Chemotherapy and other medicines

These medicines may cause kidney problems:

• Chemotherapy drugs such as cisplatin, carboplatin, ifosfamide, and methotrexate
• Antibiotics such as tobramycin, gentamicin, and amphotericin
• Medicines for graft-versus-host disease (a complication of stem cell transplant). These medicines include cyclosporine and tacrolimus.

Surgery

These surgical procedures may cause kidney problems:

• Removal of 1 or both kidneys (nephrectomy)
• Removal of bladder (cystectomy)

Other risk factors

Other risk factors include:

• High blood pressure
• Diabetes
• History of urinary tract problems such as frequent urinary tract infections and urinary reflux (backward flow of urine)

Symptoms of kidney problems

Most people do not have symptoms until kidney disease has become very advanced. 

Signs and symptoms may include:

• Swelling in your hands and feet (edema)
• Urinary tract infections
• Protein in your urine
• Blood in your urine (hematuria)

Other symptoms your care team may notice that indicate kidney problems include:

• Low red blood cell count (anemia)
• High blood pressure (hypertension)

Kidney damage may appear on imaging tests such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) or be detected on a biopsy.

What survivors can do

Know your risks and monitor health

• Ask your oncologist about your risk for late effects.
• Tell your primary care provider about your risk. Share a copy of your  Survivorship Care Plan. It includes details about your cancer treatment and about possible health problems.
• Have a yearly physical exam with a blood pressure check.
• Have blood tests for kidney function at your first long-term follow-up visit. These include BUN, creatinine, and electrolyte levels
  • A high level of BUN (blood urea nitrogen) may signal a kidney problem.
  • Creatinine is a waste product of the body’s muscles. Creatinine levels measure how well kidneys filter waste from the blood. 
  • Electrolytes are minerals that help the body function. High or low levels can be a sign of kidney problems
• Patients who have had a bladder removal (cystectomy) should see a urologist  (a doctor that treats urinary disease) once a year.

Prevention

Take steps to keep your kidneys healthy:

• Drink plenty of water. Do this especially during physical activity.
• Contact a health care provider right away if you have symptoms of a urinary tract infection. Symptoms may include:
  • Pain or burning while peeing
  • Peeing more than usual
  • Feeling an urgent need to pee
• Use non-steroidal anti-inflammatory drugs (NSAIDs) with caution. These medicines include aspirin, ibuprofen, and naproxen. They can cause kidney damage. This is especially true in large doses or when you combine 2 or more of these drugs with caffeine or codeine over a long time.

Questions to ask your care team about kidney problems

• Am I at risk for kidney problems?
• What screenings do I need?
• What signs and symptoms should I look for? Which ones should I call my health care provider about?
• What can I do to lower my risk of having problems?