AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichRenal involvement in children with malignanciesAbstract Renal complications in children with malignancies primarily arise from renal parenchymal tumors,tumor lysis syndrome, and malignant infilteration or obstruction of the urinary tract. Therapy-associated renal side effects may develop following surgical and cytostatic treatment or be induced by radiotherapy. Clinically, both acute renal failures, for example following cisplatin, or chronic dysfunction, following ifosfamide and resulting in growth failure, are observed. Frequencies of renal impairment in these patients are not well established, but terminal renal failure is a rare event. Pediatric malignancies account for only 0.9% of patients on renal replacement therapy; the majority of these patients had been treated for a bilateral nephroblastoma. Since potentially serious long term renal sequelae may evolve following both single measures and additive nephrotoxic effects, long term monitoring of growth, blood pressure, and renal function is mandatory for a great proportion of former pediatric oncology patients.Polly E. KintzelAnticancer Drug-Induced Kidney DisordersAbstractChemotherapy can cause nephrotoxicity, and renal impairment can results in altered excretion and metabolism of chemotherapeutic agents. Renal dysfunction is a problematic adverse effect that can hinder continued administration of anticancer treatment, in addition to impending the optimal use of ancillary and supportive medications and measures.Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes). Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and haematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalinization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine .AbstractRainer Rossi – Robert Kleta – Jochen H.H. EhrichBackground: ”Of greater human interest than the details of design and equipment (is)…the need to appreciate the emotional strain to which members of the…(critical care) staff are exposed when, hour by hour, their whole attention is focused on patients who are immediately and constantly dependant on their vigilance”. The creation of neurointensive care unit arose from the awareness that neurosurgical critical patients require different and specialized nursing and medical care. Patients admitted to neurointensive care unit usually have one or more of the following abnormalities: altered level of consciousness, respiratory insufficiency, loss of airway protective refleces, risk of rapid deterioration in neurological function, or cardiovascular instability associated with neurological injury. Caring for the postoperative neurosurgical patient presents unique challenges to the neurosurgeon. The neurosurgeon must always keep in mind that patients in the NICU may have problems not only within the central nervous system, but also of various other organ systems. Preoperative medical conditions often profoundly complicate postoperative management. It is important to understand the effects of neurosurgical interventions on normal body homeostasis and vice versa in order to provide effective care to patients in the NICU. Of critical importance in the NICU is the prompt recognition of neurological deterioration, and timely diagnosis and management of postoperative complications. Many complications of neurosurgical disorders result from cerebral ischemia or increased intracranial pressure. Depending on their causes, these processes may be reversible, but only with timely management. The fact is, delays in detection of such treatable problems can lead to permanent neurologic damage. It is not appropriate to wait several hours to evaluate a patient, or to delay definitive imaging studies for the sake of convenicence. Uncal herniation and permanent brainstem damage can occur over a matter of minutes, and often times by the time the pupil dilates, the patient has already suffered irreversible damage. The most important first step in the care of any neurosurgical critical patient is a through evaluation as soon as he or she is admitted to the NICU. Because of the urgency in making diagnoses and instituting therapy for uneurologic problems, it is critical to have a good baseline exam as early as possible in the course of therapy. The neurologic examination should be detailed, and include documentation of the level of consciousness, cranial nerve function, speech, motor and visual systems. The initial evaluation should also include evaluation of cardiac and respiratory parameters. As soon as the patient enters the NICU, he or she should be connected to continuous cardiac and respiratory monitors. Continuous Electrocardiography (ECG), pulse oximetry and arterial pressure monitors are typically used. Often the patient may have additional monitors, such as a ventriculostomy or Intracranial Pressure (ICP) monitor, or possibly even a central venous line or Swan-Ganz catheter. Objectives: clarify the extreme importance of the creation of a separate neurointensive care unitالملخص العربىإن فكرة إنشاء وحدات خاصة ليس بمفهوم جديد ففى بداية القرن الثامن عشر تم إنشاء أقسام لتلبية احتياجات المرضى الذين لا يمكن الاهتمام بهم فى المنازل ولقد تطور هذا المفهوم فى نهاية فترة الخمسينيات عندما تم إنشاء وحدات علاجية خاصة لمرضى شلل الأطفال ومرضى الحروق.لقد حدث تطور هائل فى مفهوم وحدات العناية المركزة خلال الخمس وعشرين عاماً السابقة لدرجة أن معظم المستشفيات العامة تقريباً يوجد بها وحدة أو أكثر من وحدات العناية المركزة.لقد أصبح إنشاء وحدة عناية مركزة خاصة بالحالات الحرجة من مرضى جراحة المخ والأعصاب ظاهرة حديثة حيث أن هذه الحالات تحتاج لمتابعة مستمرة وعلاج مكثف.وكما قال الأستاذ الدكتور/ مينون ”أستاذ التخدير بجامعة كامبريدج” بالمؤتمر العلمى السنوى لأطباء التخدير الأستراليين والنيوزيلينديين فى مايو 2005 إن العناية المركزة لمرضى جراحة المخ والأعصاب ليس بعنوان يقال وإنما هو منهاج حياه يتعرف على الاحتياجات الخاصة لهؤلاء المرضى ويستخدم كل سبل المعلومات المتاحة للوصول إلى أرقى وأفضل النتائج مع هذه الحالات.إن التطور الهائل الذى يحدث فى جراحات المخ والأعصاب يتطلب من الضرورى إنشاء وحدات عناية مركزة خاصة بمرضى جراحة المخ والأعصاب (على سبيل المثال مرضى إصابات الرأس, مرضى إصابات العمود الفقرى والحبل الشوكى, مرضى نزيف تحت الأم العنكبوتية, مرضى أورام المخ والمرضى الذين أجريت لهم عمليات جراحية بالمخ وفى بعض الأحيان الذين أجريت لهم عمليات بالعمود الفقرى).كل هذا القطاع الكبير من المرضى فى أمس الحاجة إلى متابعة مستمرة وهذه المتابعة لا تمتد لساعات قليلة فقط فى غرفة الإفاقة- كما يظن البعض- وإنما قد تمتد لعدة أسابيع بعد ذلك وكلما ازدادت الوسائل التشخيصية والعلاجية تطوراً وتعقيداً كلما ازدادت الحاجة لإنشاء وحدات عناية مركزة لمرضى جراحة المخ والأعصاب.فى الآونة الأخيرة كان هناك اتجاه سائد بأن يقوم متخصص الحالات الحرجة أو طبيب العناية المركزة بعلاج كل حالات العناية المركزة قد يبدو هذا الاتجاه صحيحاً فى علاج مرضى القلب والأوعية الدموية أو مرضى الجهاز التنفسى ولكنه ليس صحيحاً فى علاج مرضى جراحة المخ والأعصاب لأنه ليس بالخبرة الكافية أو بالتدريب الكافى مثل طبيب جراحة المخ والأعصاب.ويرجع تحديد التصور الفعلى لوحدة العناية المركزة لمرضى جراحة المخ والأعصاب إلى مديرى المستشفيات والقائمين عليها وإذا ما وضعنا فى الاعتبار مرضى إصابات الرأس الخطيرة والأمراض الحادة بالمخ لأصبح من الضرورى- بل من الحتمى- إنشاء وحدة عناية مركزة لجراحى المخ والأعصاب.إن وحدة العناية المركزة العامة التى تقوم فى الغالب بعلاج الحالات الحرجة لمرضى جراحة المخ والأعصاب لا تضاهى وحدة العناية المركزة الخاصة بمرضى جراحة المخ والأعصاب فالممرضات- غالباً- ليس لديهن الخبرة الكافية فى متابعة مرضى جراحة المخ والأعصاب بالإضافة إلى أنه قد يتم استدعاء الطبيب أكثر من مرة إذا ما حدث تغير ملحوظ فى ضغط الدم أو عدم انتظام ضربات قلب المريض ولكن إذا ما اتسعت إحدى حدقتى عين المريض قد لا يتم استدعاء الطبيب على الإطلاق.وهذا لا يعد نقداً أو تجريحاً لممرضات وحدة العناية المركزة العامة بقدر ما يشير إلى حقيقة هامة جداً وهى أن مجال التمريض يجب أن تصبح فيه تخصصات شأنه فى ذلك كشأن باقى المجالات المختلفة فى الطب ويجب ألا نتوقع أن تقوم ممرضة الحالات الحرجة لمرضى القلب والأوعية الدموية بالاهتمام بالحالات الحرجة لمرضى جراحة المخ والأعصاب بكفاءة إذا لم تكن على قدر كاف من التعليم والتدريب فى مجال العناية بمرضى جراحة المخ والأعصاب وبالمثل أيضاً يجب ألا نشعر بالارتياح عندما يقوم طبيب العناية المركزة العامة بعلاج الحالات الحرجة من مرضى جراحة المخ والأعصاب (وهذا أيضاً لا يعد نقداً أو تجريحاً) علاوة على ذلك فإن وحدات العناية المركزة العامة- نادراً- ما تكون جاهزة بكل وسائل متابعة الحالات الحرجة من مرضى جراحة المخ والأعصاب لذا فإنه من الأفضل أن يكون لدينا وحدة عناية مركزة خاصة مستقلة.إن إنشاء وحدة عناية مركزة خاصة بالحالات الحرجة من مرضى جراحة المخ والأعصاب يتطلب أمرين فى غاية الأهمية. الأمر الأول ألا وهو إيجاد كادر من الممرضات على قدر كبير من التدريب والتعليم والاهتمام بمرضى جراحة المخ والأعصاب ومعرفة العلامات والأعراض المختلفة للأمراض العصبية وماذا تعنى وكيفية التعامل معها بكفاءة فى حالة غياب طبيب جراحة المخ والأعصاب مؤقتاً. الأمر الثانى هو إيجاد أجهزة متابعة للمرضى سواء كانت هذه الأجهزة تقليدية (مثل أجهزة متابعة القلب, التنفس, النبض, قياس ضغط المخ وجهاز دوبلر للأشعة التليفزيونية على المخ) أو غير تقليدية (مثل الأجهزة المستخدمة لقياس الجهود المستحثة وقياس معدل سريان الدم بالمخ).حدث تطور هائل فى مفهوم العناية الخاصة بمرضى جراحة المخ والأعصاب وذلك بعد إنشاء المنظمة العالمية الخاصة بمرضى جراحة المخ والأعصاب فى فبراير 2003 وهذه المنظمة تضم العديد من العاملين فى مختلف المجالات الطبية والذين يولون اهتماماً أساسياً بمرضى جراحة المخ والأعصاب.فى النهاية يجب أن نتذكر أن العناية الحرجة هى مفهوم للعناية يتطلب أفكاراً وملاحظات خاصة وليس فقط القدرة على امتلاك التقنيات الحديثة فإذا لم يتم التدريب الكافى للطبيب المقيم أثناء فترة إقامته وتعرضه الدائم والمستمر للحالات الحرجة من مرضى جراحة المخ والأعصاب فسوف يتدهور تدريجياً مستوى علاج مثل هذه الحالات تماماً مثلما تتدهور المواهب الجراحية إذا لم تصقل بالخبرات الجراحية الكافية.الهدف من العمل:أولاً: توضيح مدى أهمية إنشاء وحدة عناية مركزة خاصة بالحالات الحرجة من مرضى جراحة المخ والأعصاب.ثانياً: مناقشة التغيرات الفسيولوجية والمرضية المختلفة وأجهزة المتابعة والأساليب الحديثة لعلاج الحالات الحرجة من مرضى جراحة المخ والأعصاب بوحدة العناية المركزة مع الاهتمام الخاص بالحالات التى قد أجريت لها عمليات جراحية وكيفية متابعتها وكيفية علاج بعض المضاعفات المتوقع حدوثها على الوجه الأمثل.وسوف أناقش ما يلى:(1)كيفية تصميم وإنشاء وحدة عناية مركزة خاصة بمرضى جراحة المخ والأعصاب.(2)الجهاز التنفسى: علاج الأمراض المتعلقة به بالعناية المركزة.(3)الجهاز الدورى: علاج الأمراض المتعلقة به بالعناية المركزة.(4)الجهاز العصبى: المنظور الفسيولوجى وطرق متابعته بالعناية المركزة.(5)علاج ارتفاع الضغط داخل الجمجمة.(6)الطرق المختلفة للمتابعة السريرية للمريض بالعناية المركزة.(7)السوائل والإلكتروليتات: المنظور الفسيولوجى وعلاج الأمراض المتعلقة بها بالعناية المركزة.(8)التغذية والتمثيل الغذائى والهرمونات بالعناية المركزة.(9) الطرق المختلفة لمنع التجلط بمرضى جراحة المخ والأعصاب بالعناية المركزة.(10)علاج إصابات الرأس الخطيرة بالعناية المركزة.(11)علاج إصابات الحبل الشوكى الحادة بالعناية المركزة.(12)علاج حالات جلطات المخ بالعناية المركزة.(13)علاج حالات نزيف تحت الأم العنكبوتية بالعناية المركزة.(14)طرق المتابعة والمضاعفات المتوقعة بعد إجراء العمليات الجراحية وكيفية علاجها.(15)علاج مرضى الصرع بالعناية المركزة.(16)العدوى: كيفية منعها وطرق علاجها بالعناية المركزة.(17)مرضى جراحة المخ والأعصاب ”من الأطفال” بالعناية المركزة.(18)الطرق المختلفة لحماية المخ.(19)إعلان موت جذع المخ.