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Renal QuickFact

Childhood cancer survivors can be at risk for developing the following  renal and genitourinary late effects:

  • Bladder Dysfunction
    • Bladder Fibrosis
    • Hemorrhagic Cystitis
  • Urinary Tract Toxicity
    • Vesicoureteral Reflux (VUR)
    • Dysfunctional Voiding
    • Chronic Urinary Tract Infections
  • Renal Toxicity
    • Glomerular Injury
    • Tubular Injury
    • Renal Insufficiency
    • Proteinuria
    • Hyperfiltration
  • Hypertension (HTN)
  • Hydronephrosis
  • Hydrocele
  • Incontinence/Neurogenic Bladder
  • Genitourinary Dysfunction

For Gonadal late effects visit the Ovary/Testis Quick Fact:

  • Gonadal Dysfunction
  • Uterine Vascular Insufficiency
  • Sexual Dysfunction

If your patient does not have a Survivor Health Plan (SHP), please refer

him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for pulmonary late effects:


·         Age at treatment                                  

·         Time since treatment

·         Total dose of radiation

·         Total dose of chemotherapy

·         Retroperitoneal node dissection

·         Single kidney

·         Bilateral Wilms tumor

·         WAGR syndrome

·         Denys-Drash syndrome

·         Chronic graft-vs-host disease

·         Hypospadias

·         Cryptochidism

·         Diabetes mellitus

·         Alcohol use

·         Hypertension

·         Smoking

 

Chemotherapy

Table 1

 

Bladder Dysfunction

Urinary Tract Toxicity

Renal Toxicity

Hypertension 

Hydronephrosis

Hydrocele

Incontinence

GU Dysfunction

Alkylating Agents                                                                  

Carmustine

   BCNU

Busulfan

Lomustine

   CCNU

Chlorambucil Cyclophosphamide

   Cytoxan

Ifosphamide

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

X

Cyclophosphamide and Ifosphamide only

X

Cyclophosphamide and Ifosphamide only

X

Ifosphamide only

 

X

Cyclophosphamide and Ifosphamide only

 

 

 

Heavy Metals

Carboplatin

Cisplatin

 

 

 

X

  X

 

 

 

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

X

Methotrexate only

X

Methotrexate only

 

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

 

 

 

 

 

 

 

 

Chemotherapy

Table 2

Bladder Dysfunction

Urinary Tract

Toxicity       

Renal Toxicity   

Hypertension

Hydronephrosis

Hydrocele

Incontinence

GU Dysfunction

Anti-tumor antibiotics

Bleomycin

Dactinomycin

 

 

 

 

 

 

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

 

 

 

 

 

 

 

Enzymes

Asparaginase

 

 

 

 

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

 

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

 

 

 

 

 

 

Radiation

Bladder Dysfunction

Urinary Tract Toxicity

Renal Toxicity

Hypertension

Hydronephrosis

Hydrocele

Incontinence

GU Dysfunction

All Radiation                       

 

 

 

 

 

 

 

 

TBI

 

 

X

X

 

 

 

 

Head/Brain

 

 

 

 

 

 

 

 

Neck

 

 

 

 

 

 

 

 

Thorax

 

 

 

 

 

 

 

 

Abdomen

 > 30 Gy

 

Include TBI in total dose calculation

> 30 Gy

 

Include TBI in total dose calculation

X

X

> 30 Gy

 

Include TBI in total dose calculation

 

 

Vaginal Fibrosis/

Stenosis

Pelvis

> 30 Gy

 

Include TBI in total dose calculation

> 30 Gy

 

Include TBI in total dose calculation

 

 

> 30 Gy

 

Include TBI in total dose calculation

 

 

Vaginal Fibrosis/

Stenosis

Extremity

 

 

 

 

 

 

 

 

 

Hematopoeitic Stem

Cell Transplant

Bladder Dysfunction

Urinary Tract Toxicity

Renal Toxicity

Hypertension

Hydronephrosis

Hydrocele

Incontinence

GU Dysfunction

Hematopoeitic                

Stem Cell 

Transplant

 

 

 

X

 

 

 

 

 

Vaginal Stenosis/

Fibrosis

( with any

history

of chronic

GVHD)

Surgery

Bladder Dysfunction

Urinary Tract Toxicity

Renal Toxicity

Hypertension

Hydronephrosis

Hydrocele

Incontinence

GU Dysfunction

Cystectomy       

 

X

X

 

X

X

X

Cysectomy Related Problems

Hysterectomy

 

 

 

 

 

 

X

Pelvic Floor Dysfunction

Neurosurgery – Spinal Cord

 

 

 

 

 

 

X

 

Pelvic Surgery

 

X

 

 

 

X

X

 

Nephrectomy

 

 

X

 

 

X

 

 

Oopherexy

 

 

 

 

 

 

 

Pelvic Adhesions and Ovarian Cysts

For recommendations on how to screen for all potential late effects please refer to The Children's Oncology Group Long-term Follow-up Guidelines.

Health Links-Teaching Handouts from The Children's Oncology Group       

Visit http://www.survivorshipguidelines.org/ to find many of the Health Links translated into other languages.

Reference:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 2/10/2015 8:11:54 PM
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