Renal and Genito-Urinary
Monitoring
It is really important to maintain kidney function if there has been any previous damage to renal reserve from therapy such as nephrectomy, renal RT or nephrotoxic chemotherapy.
General advice:
- After nephrectomy, avoid contact sports (such as rugby or American football). Injury to the remaining kidney would result in renal failure.
- Urinary tract infections should be treated very promptly to preserve remaining renal tissue.
- Care should be taken about different medications (eg. non-steroidal anti-inflammatory drugs) which might be associated with further kidney damage.
Follow up:
Examination: Patients at risk for renal and genito-urinary late effects should be examined every year and one of the most important evaluations in follow up is to check the patient's blood pressure (BP).
The definition of hypertension is: BP level at or above the 95th percentile on at least three occasions. If the BP level meets the definition of hypertension, evaluation
and treatment is indicated.
Blood work every year to check CBC, lytes, serum creatinine and blood urea nitrogen (BUN).
If there is a history of exposure to a drug which has resulted in tubular damage (such as ifosphamide and cisplatin), serum magnesium and phosphate must be checked every year.
Urinalysis:
This should probably be performed every year to check for hematuria and proteinuria.
Imaging:
An annual ultrasound scan of the kidneys and abdomen helps to rule out the development of hydronephrosis.
Any concern about renal function should prompt referral to a nephrologist for detailed evaluation.
Link to:
COG Survivorship Guidelines: Kidney Health after cancer
COG Survivorship Guidelines: Single kidney health
Bladder monitoring:
Previous treatment with cyclophosphamide and radiation therapy (RT) is associated with bladder fibrosis and an increased risk of bladder cancer.
It is presently unclear when screening with cystoscopy is indicated in patients with a history of these previous exposures, but any symptoms such as hematuria should be investigated promptly and thoroughly.
Patients who have a history of pelvic RT should have a rectal examination every year and intermittent ultrasound scans to exclude RT induced malignancy.
They should also have screening for colon cancer at an earlier age than other individuals because of the increased risk of a second malignant neoplasm.
COG Survivorship Guidelines: Bladder health
Other Guidelines:
COG Survivorship Guidelines: Cystectomy and childhood cancer
COG Survivorship Guidelines: Neurogenic bladder following treatment for childhood cancer
