Pathophysiology of Cisplatin-Induced Acute Kidney Injury

Table 1

General measures for prevention and treatment of cisplatin-induced AKI.

(1) Determine renal function (GFR) before each session of cisplatin treatment
(2) Determine the risk of AKI (high risk; females, elderly patients, dehydration, patients with CKD and repeated doses of cisplatin)
(3) Adjust cisplatin dose according to patient's renal function
(4) Start hydration (with saline) before cisplatin and maintain for at least 3 days after treatment
(5) Watch for electrolyte wasting (e.g., Mg), replace appropriately
(6) Avoid concomitant nephrotoxic agents (NSAIDs, aminoglycosides, contrast agents, etc.)
(7) Determine renal function within 1 week of treatment
(8) Amifostine may be considered in patients with high risk of AKI
(9) Consider newer, less nephrotoxic platinums such as carboplatin and oxaliplatin

GFR: glomerular filtration rate, AKI: acute kidney injury, CKD: chronic kidney injury, Mg: magnesium, and NSAIDs: nonsteroid anti-inflammatory drugs.