Chemotherapy-related complications in the kidneys and collecting system: an imaging perspective

Jia, Jemianne Bautista; Lall, Chandana; Tirkes, Temel; Gulati, Rajesh; Lamba, Ramit; Goodwin, Scott C.

doi:10.1007/s13244-015-0417-x

Insights into Imaging

Table 1 Table summarizing adverse effects in the kidneys and collecting system visible on imaging and associated cancer therapies

From: Chemotherapy-related complications in the kidneys and collecting system: an imaging perspective

Adverse effect	Associated agents	Laboratory findings	Radiologic findings
Complex renal cysts	Crizotinib	None	US- Ovoid, anechoic cysts with clearly demarcated walls, no septa or calcifications, near water density
Complex renal cysts	Crizotinib	None	CT- Bosniak III-IV complex cysts
Interstitial nephritis	Ipilimumab	↑Plasma creatinine	Urography- Enlarged kidneys, dense persistent nephrogram
	Sorafenib	Azotemia	Urography- Enlarged kidneys, dense persistent nephrogram
		FENa> 1 %	US- Enlarged kidneys
		Eosinophiluria	US- Enlarged kidneys
		Proteinuria	CT- Renal edema and enlargement, streaky parenchymal low-attenuation areas
		Pyuria
Renal papillary necrosis	Nedaplatin	↑ Plasma creatinine	Urography- Irregular contour of the renal papillae and widening of the fornixes, “ball on a tee sign”
		Azotemia
		Leukocytosis
		Hematuria
		Proteinuria	US- Multiple cystic spaces in the medullary region arranged around the renal sinus, non-shadowing soft tissue masses within the ureter
		Pyuria
		Pyuria	CT- Excavation of the calyces, regression of the papillae, blunting of the calyces, detached papillae in the ureter
Renal infarction	Methotrexate	↑ Lactate dehydrogenase Hematuria	Urography- Absence of contrast material in infarcted parenchyma
	Combination Cisplatin and Gemcitabine Regimens	↑ Lactate dehydrogenase Hematuria
		Proteinuria
			US- Heterogeneity of parenchyma
			CT- Low attenuation, wedge shaped areas in the cortex, “rim sign”
Acute tubular necrosis	Cisplatin	↓ GFR	Urography- Renal enlargement with prolonged opacification of the renal parenchyma, increase in density of the pyramids
	Ifosfamide
	Imatinib
			US- Cortical echogenicity
			CT- Contrast retention in the parenchyma, “rim sign”
		↓ Urine osmolality
		↓ Urine/plasma creatinine ratio
		Urine sediment: renal tubular epithelial cells, epithelial cell casts, and muddy brown granular casts
Chemotherapy cystitis	Intravesical Mitomycin C	Hematuria	Urography- Small bladder with thickened walls, calcifications within the walls may be present
			CT- Diffuse or focal irregular bladder wall thickening, decreased bladder volume and perivesical fat, edema
			MRI- High T2 signal within the bladder wall
Hemorrhagic cystitis	Cyclophosphamide	Hematuria	CT- Bladder wall thickening
	Ifosphamide
	Busulfan
	Cabazitaxel

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