KIDNEY PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
PLAIN version 4: 01/04/2026
This PLAIN summary is based on the PanCare Follow-Up guideline about “Renal problems” [1], which is based on the corresponding IGHG* guideline [2].
Kidney (renal) problems
The kidneys are a pair of organs located on each side of the spine. The kidneys make urine by filtering excess water and waste from the blood. The urine is then stored in the bladder until you pass it. For more information on lower urinary tract problems, please read: Lower urinary tract problems.
Sometimes problems can occur with the kidneys. Kidney (renal) problems include:
- Glomerular dysfunction, where the tiny filters in the kidneys become damaged. When this happens, blood cells and proteins that should remain in the bloodstream, pass through the filters and end up in the urine. In addition, the speed at which the kidneys filter blood may become slower.
- Tubular dysfunction, where the parts of the kidney that reabsorb water and some important substances (such as potassium, phosphate, magnesium, glucose) become damaged. When this happens, the kidney can no longer reabsorb enough water (and substances such as potassium) after it is filtered.
Am I at higher risk of kidney problems?
Anyone, including people who have never had cancer treatment, may develop kidney problems. However, there are some medical conditions and cancer treatments that may increase the risk of having kidney problems later in life. The problems that can occur depend on the type of cancer treatment received.
The following medical conditions can cause liver problems:
- Hypertension, where your blood pressure is too high. For more information on high blood pressure, please read: Hypertension.
The following treatments can increase the risk of kidney problems:
- Chemotherapy drugs, for example ifosfamide, cisplatin, and carboplatin
- Any dose of radiotherapy to the kidney(s), or an area that includes the kidney(s), including radiotherapy to the entire body (also known as total body irradiation [TBI])
- Stem cell transplantation
- Surgery that involves removal of a kidney (nephrectomy)
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience kidney problems, it does not always mean that this is caused by your cancer treatment. Kidney problems may have other causes such as pre-existing high blood pressure diabetes. For more information on high blood pressure and diabetes please read: Hypertension and Impaired glucose metabolism and diabetes.
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Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of kidney problems?
There are symptoms and signs that can tell you if you might have kidney problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
In early stages, kidney problems usually do not lead to any symptoms. These symptoms and signs may suggest that you have kidney problems:
- High blood pressure (hypertension) symptoms and signs. For more information on hypertension, please read: Hypertension.
- Swelling of the legs or other parts of the body (eg. around the eyes especially in children)
- Passing urine more or less frequently than usual
- Blood in the urine
- Frothy or foaming urine
If you recognise any of these symptoms or signs in yourself, please contact a general practitioner or follow-up care specialist.
Symptoms and signs
I am at higher risk of kidney problems. What tests should I have and when?
If you received treatment with the chemotherapy drugs ifosfamide, cisplatin, carboplatin, radiotherapy to a volume exposing the kidney (including TBI) and/or surgery involving removal of a kidney (nephrectomy), it is advised to:
- have a blood test to allow calculation of the estimated glomerular filtration rate (eGFR) measure creatinine) at least every 2- 5 years.
- have a blood pressure check every year
In addition, if you received treatment with ifosfamide and/or radiotherapy to a volume exposing the kidney (including TBI), it is advised to:
- have a urine test (to measure protein) at least every 2-5 years.
In addition, if you received the chemotherapy drugs ifosfamide and/or cisplatin, it is advised to also measure phosphate, magnesium, potassium and bicarbonate in the blood once at the end of treatment. If any abnormalities are present at the end of treatment, repeat tests should be performed when medically necessary.
What happens if I have kidney problems?
If you have kidney problems, your general practitioner or follow-up care specialist will probably refer you to a:
- Nephrologist (physician specialised in the kidneys)
The nephrologist may perform further blood and urine tests and discuss different treatment options with you.
What else can I do?
Knowing that you may be at increased risk of kidney problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
It is important to drink enough fluid each day and to avoid excessive amounts of salt and/ or protein in your diet. Also be careful about taking medication such as ibuprofen and aspirin as these may damage the kidney. If you are currently living with one kidney, it is important to protect your kidney from injury. Be careful about taking medication such as ibuprofen and aspirin as these may damage the kidney. If you have questions about the right amount of fluid, salt and protein intake for your specific situation, please contact your general practitioner or follow-up care specialist.
If you are currently living with one kidney, it is important to protect your kidney from injury.
If you are at risk of kidney problems or if you experience kidney problems, adopting or maintaining a healthy lifestyle is extremely important. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing kidney problems and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Ibuprofen
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about kidney problems online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- National Kidney Foundation: Here you can find more information about contact sports for children with kidney disease
- Kidney Care UK: Here you can find more information about kidney problems in general and about support for those affected by it in the UK
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCare Follow-Up guideline about “Renal problems” [1], which is based on the corresponding IGHG* guideline [2].
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
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.
*International Guideline Harmonization Group for Late Effects of Childhood Cancer
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext
[2] Kooijmans, E. C. M. et al. (2025) Nephrotoxicity Surveillance for Childhood and Young Adult Survivors of Cancer: Recommendations From the International Late Effects of Childhood Cancer Guideline Harmonization Group. Available at: https://ascopubs.org/doi/10.1200/JCO-24-02534?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
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.
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