Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Patient Information [NCI]-Urinary System Kidney

Certain chemotherapy drugs increase the risk of kidney late effects.

The risk of health problems that affect the kidney increases after treatment with the following:

• Chemotherapy drugs including cisplatin, carboplatin, ifosfamide and methotrexate.
• Radiation therapy to the middle of the back or abdomen.
• Surgery to remove part or all of a kidney.
• Stem cell transplant.

The following may also increase the risk of kidney late effects:

• Having cancer in both kidneys.
• Age at the time of treatment. Older children treated with cisplatin and carboplatin are at greater risk. Younger children (5 years and younger) treated with ifosfamide are at greater risk.
• Having a genetic syndrome that increases the risk of kidney problems, such as Denys-Drash syndrome or WAGR syndrome.
• Having tuberous sclerosis, a genetic syndrome that may increase the risk of kidney cancer in childhood cancer survivors.
• Having an abnormal genitourinary system (in men).

Late effects that affect the kidney may cause certain health problems.

Kidney late effects include the following:

• Damage to the parts of the kidney that filter and clean the blood.
• Damage to the parts of the kidney that remove extra water from the blood.
• Loss of electrolytes, such as magnesium, calcium, or potassium, from the body.
• Hypertension (high blood pressure).

Possible signs and symptoms of kidney late effects include changes in urination and swelling of the feet or hands.

These and other signs and symptoms may be caused by kidney late effects or by other conditions:

• Feeling the need to urinate without being able to do so.
• Frequent urination (especially at night).
• Trouble urinating.
• Feeling very tired.
• Swelling of the legs, ankles, feet, face, or hands.
• Itchy skin.
• Nausea or vomiting.
• A metal-like taste in the mouth or bad breath.
• Headache.

Sometimes there are no symptoms in the early stages. Symptoms may appear as damage to the kidney continues over time. Talk to your child's doctor if your child has any of these problems.

Certain tests and procedures are used to detect (find) and diagnose health problems in the kidney.

These and other tests and procedures may be used to detect or diagnose kidney late effects:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
• Blood chemistry study: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as magnesium, calcium, and potassium, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance may be a sign of kidney disease.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
• Twenty-four-hour urine test: A test in which urine is collected for 24 hours to measure the amounts of certain substances. An unusual (higher or lower than normal) amount of a substance, such as protein, urea nitrogen, or creatinine, can be a sign of disease in the organ or tissue that makes it.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the kidney, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

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