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Healthy living after treatment of childhood, adolescent, and young adult cancer

Kidney Health after Cancer Treatment
The kidneys are vital organs responsible for filtering out waste products from the blood, controlling blood pressure,and stimulating red blood cell production. Treatment for childhood cancer can sometimes damage the kidneys. It is
important to understand how the kidneys function so that you can keep your kidneys as healthy as possible.
How do the kidneys work?

The kidneys are two bean-shaped organs, each approximately the size of an adult fist,
located below the rib cage near the middle of the back. The kidneys filter about 200 quartsof blood each day, removing harmful waste products and excess water, and returning
important elements (such as calcium, sodium and potassium) to the blood. Filtering occurs
in tiny units inside the kidneys, known as nephrons. Each kidney has approximately one
million nephrons. After the blood is filtered by the nephrons, the excess water and waste
products become urine. The urine flows from the kidneys to the bladder through tubes
called ureters. The bladder then stores the urine until it is full, at which time the waste is
emptied from the body through the urethra.
How is kidney function measured?

Kidney function is measured by calculating a glomerular filtration rate, or GFR. The GFR isa measure of how much blood your kidneys can filter each minute. The GFR is calculatedusing blood test results and information like your age, sex and height. A GFR of greaterthan 90 mL/min/1.73 m2 is considered normal. If your GFR is below 90 mL/min/1.73 m2,
your provider may order additional tests such as a urinalysis to see if there is protein or
blood in your urine.
What treatments for childhood cancer can cause kidney problems?

Certain treatments used for childhood cancer can sometimes cause kidney problems. There may also be other risk
factors present that can increase the chance of kidney problems. If you have any of the following risk factors, you
should take extra care to keep your kidneys healthy:
Radiation involving the kidneys, including:• Kidney (renal or flank) radiation• Abdominal radiation•

Total body irradiation (TBI)Certain medications that can cause kidney damage, including:• Cisplatin• Carboplatin• Ifosfamide• Certain antibiotics used to treat bacterial and fungal infections, such as tobramycin, gentamicin, and amphotericin•

Certain medications used to treat graft-versus-host disease, such as cyclosporine and FK-506 (tacrolimus)

Other risk factors that may increase the chance of kidney problems include:• Nephrectomy (surgical removal of a kidney)—see the related Health Link: Single Kidney Health• Hematopoietic cell transplant (HCT)

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Healthy living after treatment of childhood, adolescent, and young adult cancer

Medical conditions that may affect the kidney, such as high blood pressure, diabetes, or a tumor involving thekidney• History of urinary tract problems, such as frequent urinary tract infections, back-flow of urine into the kidney(reflux), or other urinary tract abnormalities• Cystectomy (removal of the bladder)—this increases the risk of chronic urinary tract infections and other kidney
problems•

What are the signs and symptoms of a kidney problem?

••••

Swelling, especially of the feet and ankles (edema)
Low red blood count (anemia)
High blood pressure (hypertension)
People who have signs of serious kidney problems, such as edema, low red blood count, and hypertension, mayalso have other symptoms, including fatigue, nausea and vomiting, drowsiness, itchy skin, or headaches

What follow up is recommended?

Have a medical check-up at least yearly. This should include a blood pressure check.
Have blood test for kidney function (BUN and creatinine) and electrolytes (blood salts and minerals) at yourfirst long-term follow up visit (at least 2 years after completing cancer treatment). Depending on the treatment
you received and the results of this lab work, your provider may recommend labs to assess your kidney function at
regular intervals.
• If you had a cystectomy (bladder removal), you should also have an evaluation by an urologist (urinary tractspecialist) at least once a year.
••

What can I do to keep my kidneys healthy?

••

Drink plenty of water, especially when playing sports, while out in the sun, and during hot weather.
Call your healthcare provider immediately if you have symptoms of a urinary tract infection (burning when youurinate, urinating more frequently than usual, and/or feeling an urgent sensation to urinate).
• Use non-steroidal anti-inflammatory drugs with caution. These include pain or fever medicines (over-the-counterand by prescription) that contain aspirin, ibuprofen, or naproxen. These medications have been known to causekidney damage (analgesic nephropathy), especially when taken in high doses or over long periods of time (morethan 10 days). If you require long-term medications for management of pain, be sure to discuss options with yourhealthcare provider, and to choose medications that are safe for your kidneys.
Written by Anne Mauck, RN, MSN, CPNP, Virginia Commonwealth University/Massey Cancer Center, Richmond, VA.
Reviewed by Kayla L. Foster, MD, MPH; and Melissa Acquazzino, MD, MS.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health Links
were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s Oncology
Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a
medical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.

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Healthy living after treatment of childhood, adolescent, and young adult cancer
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
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