Effects on the Urological System

Many of the breakdown products of chemotherapy drugs are excreted through the kidneys. These drug byproducts can damage the kidneys, ureters, and bladder. Some of the cytotoxic agents known for their potential nephrotoxic effects are ifosfamide, cyclophosphamide, cisplatin, methotrexate, streptozocin, carmustine, and lomustine. Renal dysfunction can include hemorrhagic cystitis, oliguria, dysuria, an increased creatinine level, and low back pain. It is important to assess whether the patient is on other drugs that may also be nephrotoxic, such as aminoglycoside antibiotics.

Management strategies for the effects of chemotherapy on the urological system include:

a. Monitoring renal function by checking serum creatinine, and creatinine clearance values before treatment.
b. Encouraging the patient to drink enough fluids before and after treatment. Ensuring adequate hydration before and after treatment by giving fluids orally and intravenously.
c. Maintaining adequate diuresis (100 ml per hour for 2 to 4 hours before treatment and 4-6 hours after treatment).
d. Alkalinizing the urine to a ph of more than 7 to prevent precipitate formation with high dose methotrexate.
e. Giving uroprotectant drugs to enhance uric acid excretion if ordered.
f. Teaching the patient to void frequently, especially at bedtime to prevent urinary stasis.
g. Instructing the patient to avoid foods that may irritate the bladder, such as coffee, tea, alcohol, and spices.
h. Teaching the patient signs and symptoms of renal toxicity, such as headache, pain in the lower back, fatigue, weakness, nausea, vomiting, increased blood pressure, increased rate of breathing, change in urinary patterns, change in urine color, urgent need to urinate, swelling or puffiness of the body and when to report them.

Patients receiving potentially nephrotoxic chemotherapy drugs should limit fluids when receiving chemotherapy.