Evidence-based recommendation for surveillance of renal problems (IGHG^a)
This page is part of the PanCare Follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for renal problems?

CAYA cancer survivors treated with

• ifosfamide
• cisplatin
• carboplatin
• radiotherapy to volume exposing the kidney, including TBI
• nephrectomy
• hypertension

What renal problems might occur?

• Glomerular dysfunction
• Tubular dysfunction

What surveillance modality should be used and at what frequency should it be performed?

Survivors at risk:

• Blood pressure measurement
  every year, starting at entry into long-term follow-up
• Glomerular and tubular function testing

* If cystatin C is available, use of a creatinine- and cystatin C based GFR estimating equation (eGFRcreat-cys) is recommended.
The use of a creatinine and cystatin C based GFR estimating equation (eGFRcreat-cys) is recommended in at-risk survivors in clinical
settings ^b when creatinine-based estimated GFR (eGFRcreat) is less accurate and GFR affects clinical decision-making

What other advice should be given with a nephrectomy?

• Counselling regarding lifestyle habits that are important to maintain or improve kidney health is recommended for all survivors at risk, regardless of kidney function
• Education about caution in the use of nephrotoxic medication (e.g., NSAIDs)
• Education about the importance of hydration and caution about salt and protein intake
• Seek prompt medical attention with symptoms of a urinary tract infection
• Counselling about single kidney-related health risks

What should be done if abnormalities are identified?

• Confirm an albumin-to-creatinine ratio ≥3 mg/mmol (≥30 mg/g) with an early morning urine sample
• Confirm a decreased GFR (<90 ml/min/1.73m2) after ≥3 months and ensure adequate rehydration
• In survivors with a confirmed GFR <60 ml/min/1.73m², albumin-to-creatinine ratio >30 mg/mmol (>300 mg/g), or electrolyte imbalance(s), refer to or consult with a nephrologist for further (kidney function) evaluation, interpretation of laboratory findings, potential treatment, and follow-up
• In survivors with an albumin-to-creatinine ratio >3 mg/mmol (>30 mg/g) or survivors below the age of 40 years who have a GFR <75 ml/min/1.73m², consider referral to or consultation with a nephrologist (depending on local practice) for further (kidney function) evaluation, interpretation of laboratory findings, potential treatment, and follow-up
• Electrolyte supplementation as guided by serum biochemistry if an electrolyte imbalance is detected

Disclaimer

While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

PanCareFollowUp has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 824982. The material presented and views expressed here are the responsibility of the author(s) only. The EU Commission takes no responsibility for any use made of the information set out.