Kidney International (2013) 84, 421–422; doi:10.1038/ki.2013.50

Nephrology Crossword: Onco-nephrology—chemotherapy agents and nephrotoxicityKenar D. Jhaveri1 and Steven Fishbane1

1Division of Kidney Diseases and Hypertension, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Great Neck,New York, USA

Correspondence: Kenar D. Jhaveri, Division of Kidney Diseases and Hypertension, Hofstra North Shore-LIJ School of Medicine,Great Neck, New York 10021, USA. E-mail: kdj200@gmail.com

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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 chemother-

apeutic 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 3þ 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)

http://www.kidney-international.org m a k e y o u r d i a g n o s i s

& 2013 International Society of Nephrology

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 4100 mg/dl. Clinically, the

patient is orthostatic and requires 3–5 liters 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)

Kidney International (2013) 84, 421–422 421

Nephrology Crossword Answers: Onco-nephrology—chemotherapy agents and nephrotoxicity

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m a k e y o u r d i a g n o s i s KD Jhaveri and S Fishbane: Onco-nephrology

422 Kidney International (2013) 84, 421–422