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After treatment and remission

Kidneys

Some leukaemia treatments — certain antibiotics, antifungal medicines, immunosuppressants after transplant and radiation — can affect the kidneys. This topic explains how the kidneys are checked and how to protect them.

Last updated: ~3 min read
Glowing kidneys with clear streams of light passing through.
Figure 1.The kidneys filter the blood.

01Short answer

The kidneys filter the blood and regulate fluid and salt balance, blood pressure and red cell production. During leukaemia treatment several factors can affect them: high-dose methotrexate, some antibiotics (for example aminoglycosides, vancomycin) and antifungals (amphotericin), immunosuppressants after transplant such as ciclosporin and tacrolimus, total body irradiation, as well as tumour lysis syndrome and severe infections. Most often kidney function recovers, but some people are left with a long-term reduction or high blood pressure. The COG recommends regular blood pressure, creatinine (eGFR) and urine tests for these people. To protect your kidneys: drink enough fluids, control blood pressure and blood sugar, avoid long-term NSAID painkillers and agree all medicines with your doctor.

02Simple explanation

The kidneys filter the blood and regulate blood pressure.

Some medicines and radiation can affect them.

Function most often recovers.

Checks: creatinine, eGFR, urine, blood pressure.

Avoid long-term NSAIDs.

03Scientific explanation

Kidney-toxic medicines: the COG recommends kidney follow-up after methotrexate, aminoglycosides, amphotericin, ciclosporin/tacrolimus and ifosfamide.

eGFR: the glomerular filtration rate, estimated from creatinine, age and sex, shows kidney function (MedlinePlus).

Transplant: after an allogeneic transplant, calcineurin inhibitors and total body irradiation raise the risk of chronic kidney disease.

Blood pressure: the NIDDK notes that high blood pressure is both a cause and a result of kidney damage; controlling it protects the kidneys.

04What happens in the body?

What do the kidneys do?

They clean waste from the blood, regulate fluid and salts, control blood pressure and support red cell production through the hormone erythropoietin.

What can affect them?

Some chemotherapy medicines, antibiotics, antifungals, immunosuppressants after transplant, radiation and severe infections.

A small filter of glowing loops with droplets passing through.
Figure 2.A nephron is the kidney’s tiny filter.

How are the kidneys checked?

Creatinine and eGFR in the blood, protein and blood in the urine, and blood pressure. When needed, a kidney ultrasound.

Which signs matter?

Swelling of the legs or around the eyes, passing less urine or foamy urine, high blood pressure and tiredness. In early stages there are often no symptoms — which is why tests matter.

How to protect your kidneys

Drink enough water (unless your doctor has limited it), watch blood pressure and sugar, cut down on salt, and avoid NSAIDs and “detox” products.

A glass of glowing water beside a calm pulse wave.
Figure 3.Fluids and normal blood pressure protect the kidneys.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Protecting the kidneys

Steps of kidney follow-up.

Tests — Creatinine, eGFR, urine.1TestsCreatinine, eGFR, urine.
Pressure — Measure regularly.2PressureMeasure regularly.
Medicines — Agree painkillers with your doctor.3MedicinesAgree painkillers with your doctor.
Fluids — Enough water.4FluidsEnough water.
KidneysFunction is monitored.
BalanceFluids and pressure controlled.
ProtectionHarmful medicines avoided.

06Kidney risk and checks (simplified)

FactorPossible effectCheck
High-dose methotrexateTemporary kidney injuryCreatinine
Aminoglycosides, amphotericinReduced functionCreatinine, electrolytes
Ciclosporin, tacrolimusChronic kidney disease, blood pressureeGFR, blood pressure
Total body irradiationLate kidney damageeGFR, urine, blood pressure
NSAID painkillersExtra strainAgree with your doctor

* Your doctor sets the testing schedule.

07Key terms

Creatinine
A waste product filtered by the kidneys.
eGFR
Estimated glomerular filtration rate.
Nephron
The kidney’s filtering unit.
Nephrotoxicity
Harmful effect of a medicine on the kidneys.
NSAID
Non-steroidal anti-inflammatory drug.
Proteinuria
Protein in the urine.

08Key points

  • The kidneys filter the blood.
  • Some treatments can affect them.
  • Function often recovers.
  • Tests and blood pressure are monitored.
  • Avoid long-term NSAIDs.
  • Drink enough water.

09Frequently asked questions

My creatinine is slightly high. Should I worry?

One result is not everything; your doctor looks at the trend and eGFR.

What can I take for pain?

Agree it with your doctor; paracetamol is usually considered safer for the kidneys, but your doctor sets the dose.

Does lots of water “flush” the kidneys?

Enough fluid helps, but too much water gives no extra benefit.

What happens if a kidney problem is found?

Treating blood pressure and other factors, and follow-up with a nephrologist if needed.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

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.

  1. My creatinine is slightly high. Should I worry?

  2. What can I take for pain?

  3. Does lots of water “flush” the kidneys?

  4. What happens if a kidney problem is found?

  5. Does this information replace medical advice?

My questions

12Sources

  1. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  2. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  3. MedlinePlus (U.S. National Library of Medicine). Kidney Tests
  4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Chronic Kidney Disease (CKD)
  5. MedlinePlus (U.S. National Library of Medicine). High Blood Pressure
  6. National Kidney Foundation. Pain Medicines (Analgesics) and kidney health
  7. National Cancer Institute (NCI). Follow-Up Medical Care
  8. National Cancer Institute (NCI). Cancer Survivorship
  9. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  10. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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