Nephrology Crossword: Onco-nephrology—chemotherapy agents and nephrotoxicity
Authors: Kenar D. Jhaveri, Steven Fishbane
Journal: Kidney International (2013)

ACROSS2. A 45-year-old male with metastatic renal cell cancer receives this agent, and 2 weeks later, develops worsening hypertension, non-nephrotic range proteinuria, anemia, and thrombocytopenia. A kidney biopsy reveals ‘pre-eclampsia’ like findings. (11)5. A 78-year-old man receives this agent for renal cell cancer after a right nephrectomy. Four weeks after treatment, he develops 15 g of proteinuria, acute renal injury, and hypoalbuminemia. This agent can also cause significant triglyceridemia as a major side effect. (9)8. This oral tyrosine kinase inhibitor used in chronic myelogenous leukemia and gastric stromal tumors rarely causes kidney damage. (9)10. A patient with lung cancer is treated with taxol and trastuzumab for 10 months. Owing to progression of diseases, a new chemotherapeutic agent is started. Five months later, the patient is noted to have increasing lactate dehydrogenase, low haptoglobin, and anemia. Few weeks later, renal function starts declining and urinalysis reveals hematuria and 3+ proteinuria. After stopping this agent, renal function improves. (11)12. This agent used to treat renal cell cancer can cause thrombotic microangiopathy, proteinuria, and acute and chronic interstitial nephritis. (9)13. A 67-year-old male with mesothelioma receives this chemotherapy and subsequently develops acute tubular injury. This agent can be retained in pleural effusions and is cleared by the kidney. (10)14. This platinum compound is the least nephrotoxic in its group. (11) DOWN1. An elderly patient with laryngeal cancer gets radiation and this chemotherapeutic agent is part of the larynx preservation protocol. Within days after administration, the patient’s serum sodium starts declining to 120 mOSm/l and urine sodium is >100mg/dl. Clinically, the patient is orthostatic and requires 3–5liters of IVF (normal saline) to keep up with the salt loss. Subsequently, hypomagnesemia is also noted. (9)3. A 45-year-old Asian man with head and neck cancer gets this chemotherapy. After 2 weeks, the patient presents to the emergency room with muscle weakness and twitching. An electrocardiogram reveals a torsades rhythm. (9)4. This cytotoxic agent is very insoluble, especially in acid and concentrated urine. Direct toxic tubular effects can arise as a result if the urine pH is not greater than 6.0. (12)6. Besides pre-eclampsia-like syndromes associated with this tyrosine kinase inhibitor, chronic interstital nephritis can be observed. (9)7. A 45-year-old man receives this chemotherapy for melanoma. Over the next 2 years, the patient develops an unexplained increase in creatinine and kidney biopsy shows chronic tubular damage and glomerulosclerosis. (10)9. A 54-year-old man who has previously failed with trabectedin (Yondelis) and radiation for myxoid sarcoma now receives this chemotherapy. After two cycles, the patient starts developing hypokalemia, hypomagnesemia, glycosuria, hypouricemia, and acute renal injury to the point of requiring dialysis within a month after chemotherapy. (10)11. This agent, also used to treat hepatitis C infection, is associated with focal segmental glomerulosclerosis and minimal change disease. (10)