Treatment and the treatment process

Protecting the kidneys

In leukemia treatment many medicines pass through the kidneys and can strain them. The team takes a few simple but important steps to protect them.

Last updated: 14 October 2026~2 min read

On a dark navy background, glowing teal kidneys under a translucent golden dome, red sparks deflecting away. — **Figure 1.**The kidneys are protected during treatment.

01Short answer

The kidneys filter the blood, remove extra fluid and waste, and clear many medicines from the body. During leukemia treatment several things can affect them: tumour lysis syndrome, dehydration (vomiting, diarrhoea, drinking little), infection and sepsis, and nephrotoxic medicines — some chemotherapy drugs (such as high-dose methotrexate), antibiotics (aminoglycosides, vancomycin), the antifungal amphotericin B, ciclosporin and tacrolimus used in transplant, contrast agents and NSAID painkillers. To protect them, creatinine and electrolytes are checked often, enough fluid is given, blood levels of some medicines are measured and doses are matched to kidney function. Kidney injury found early is often reversible.

02Simple explanation

The kidneys are a filter. They clean the blood and clear medicines.

The dangers. Some medicines, too little fluid and infection can harm them.

Checks. A creatinine test shows how the kidneys are doing.

Protection. Fluids, drug-level checks and dose changes help.

03Scientific explanation

Acute kidney injury (AKI) is defined by KDIGO criteria as a rise in creatinine or a fall in urine output. Causes are prerenal (low volume, low blood pressure), renal (tubular necrosis, crystal nephropathy, interstitial nephritis) or postrenal (obstruction).

Medicine-related mechanisms: methotrexate crystallising in acidic urine (prevented with hydration, urinary alkalinisation, level monitoring and glucarpidase if needed), tubular toxicity of aminoglycosides and amphotericin B, and vasoconstriction from calcineurin inhibitors. Therapeutic drug monitoring is used for aminoglycosides, vancomycin, ciclosporin and tacrolimus.

Dose adjustment: many antibiotics, antivirals (such as aciclovir), antifungals and some cytotoxic drugs are dosed according to kidney function (creatinine clearance or eGFR).

04What happens in the body?

How are the kidneys protected?

The team tries to prevent harm in advance: keeping fluid balance, avoiding combining too many kidney-straining medicines where possible, and checking blood tests regularly.

Tiny filters

Each kidney has about a million tiny filters called nephrons. Medicines and lack of fluid can weaken how they work.

An abstract nephron in fine teal lines with golden droplets passing through. — **Figure 2.**A nephron is the kidney’s tiny filter.

Your medicine list

Tell your team about every medicine, herbal product and supplement you take. Some add extra strain on the kidneys.

A blank medicine list card, a pen and a few closed medicine boxes on a pharmacist desk. — **Figure 3.**Review your medicine list with your team.

05A kidney protection plan

A simplified outline.

1CreatinineRegular blood tests.

2Drug levelsFor some medicines.

3FluidEnough hydration.

4Support if neededRarely, dialysis.

Less injuryEarly measures.

Doses adjustedTo kidney function.

Often reversibleWhen found early.

06What can affect the kidneys

Factor	Example	How they are protected
Tumour lysis	Start of acute leukemia treatment	Hydration, uric acid medicines
Dehydration	Vomiting, diarrhoea	Fluid replacement
Antibiotics	Aminoglycosides, vancomycin	Level checks, dose adjustment
Antifungals	Amphotericin B	Fluids, electrolyte checks
Chemotherapy	High-dose methotrexate	Hydration, level checks
Painkillers	NSAIDs	Usually avoided

* Your team chooses and doses each medicine according to your kidney function.

07Key terms

Nephron: The filtering unit of the kidney.
Acute kidney injury: A rapid decline in kidney function.
Nephrotoxic: Able to harm the kidneys.
eGFR: An estimate of how fast the kidneys filter.
Drug monitoring: Measuring a medicine’s level in the blood.
Dialysis: Cleaning the blood by machine when the kidneys fail.

08Key points

Many leukemia medicines pass through the kidneys.
Creatinine is checked regularly.
Enough fluid protects the kidneys.
Some drug levels are measured in the blood.
Don’t take painkillers or herbal products on your own.
Report a fall in urine straight away.

09Frequently asked questions

Will my kidneys fully recover?

Acute injury is often reversible, especially when found early; your doctor will explain your situation.

Why was my dose changed?

When kidney function changes, so does how the medicine leaves the body; the dose is adjusted.

Does drinking lots of water help?

Enough fluid usually helps, but your team sets the amount — too much fluid can also harm.

Is a scan with contrast dangerous?

The team checks your kidney function and takes extra protective steps if needed.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

Will my kidneys fully recover?
Why was my dose changed?
Does drinking lots of water help?
Is a scan with contrast dangerous?

My questions

12Sources

Canadian Cancer Society. Kidney problems
MedlinePlus. Acute kidney failure
NHS. Acute kidney injury
MedlinePlus. Creatinine blood test
MedlinePlus. Therapeutic drug levels
American Cancer Society. Neutropenia (Low White Blood Cell Counts)
MedlinePlus (U.S. National Library of Medicine). Sepsis
American Cancer Society. Immunotherapy for Acute Lymphocytic Leukemia
Journal of Clinical Oncology (ASCO and IDSA), 2018. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: ASCO and IDSA Clinical Practice Guideline Update
American Cancer Society. Stem Cell Transplant Side Effects

Medical disclaimerThis information is for educational purposes only and does not replace medical advice.

Last updated: 14 October 2026← Back to the list

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