cisplatin-induced acute kidney injury

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At the Brigham and Women’s Hospital & the Dana Farber Cancer Institute, there is an ongoing trial of using pneumonectomy and injected, heated cisplatin into the pleural space for patients with malignant mesothelioma, a condition with an overall poor oncologic prognosis and limited treatment options.  Apparently this technique has had some success, but not surprisingly, it results in many renal consults to the Nephrology Fellow as a very substantial percentage of patients have significant acute kidney injury and many require dialysis.  Unlike standard chemotherapy where cisplatin may be held once renal toxicity has occurred, the injected cisplatin has a very slow, continuous absorption and therefore there is no opportunity for reversal once this sets in.  

The mechanisms of cisplatin-induced acute kidney injury are still being worked out but generally result in tubular toxicity (ATN).  Both necrosis as well as apoptosis appear to be involved, according to this recent KI review article on the topic.  
Cisplatin falls under the category of platinum-containing alkylating agents.  Related drugs include carboplatin and oxaloplatin, which still have some renal toxicity but substantially less than cisplatin.  

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