Renal

Many chemotherapeutic agents are associated with the development of acute and chronic renal dysfunction. Cisplatin, ifosfamide, and carboplatin are the most nephrotoxic drugs. Cisplatin induces renal magnesium and potassium wasting, which can lead to severe hypomagnesemia and hypocalcemia (Goren 2003). Cumulative cisplatin dose over 200 mg/m2 and concomitant administration of other nephrotoxic agents (e.g.,aminoglycoside antibiotics) are risk factors for therapy-induced nephrotoxicity (Goren 2003). Ifosfamide has been associated with the development of Fanconi's syndrome (proximal tubular acidosis, hypophosphatemia, glucosuria, and aminoaciduria) that can lead to hypophosphatemic rickets. Glomerular impairment is also described with ifosfamide (Loebstein and Koren 1998; Skinner 2003). A cumulative ifosfamide dose >60 g/m2 is the most significant risk factor for the development and the severity of the nephrotoxicity (Loebstein and Koren 1998).

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