# Cancer Therapy Nephrotoxicity: Match Drug to Renal Pattern

Name the drug, identify the renal pattern, and target prevention and monitoring to that mechanism.

![Infographic: Cancer Therapy Nephrotoxicity: Match Drug to Renal Pattern](https://urinenephrology.org/visual-reference/images/student-chemotherapy-kidney.png?v=20261003c)

## Cisplatin: tubules and electrolytes

Look for AKI and magnesium wasting; follow creatinine, magnesium, potassium, and volume status. Use the oncology regimen’s hydration and electrolyte protocol and review additional nephrotoxins.

## Ifosfamide: proximal transport

Normoglycemic glycosuria, phosphate loss, bicarbonate wasting, and tubular proteinuria suggest Fanconi-type injury. A stable creatinine does not exclude clinically important proximal dysfunction.

## Methotrexate: delayed elimination

High-dose therapy requires protocolized hydration, urine alkalinization, drug-level monitoring, and rescue. Rising creatinine with delayed clearance is an urgent oncology/pharmacy problem; routine outpatient advice is inadequate.

## VEGF pathway: BP and protein

New hypertension, proteinuria, or thrombotic microangiopathy features suggest endothelial/glomerular injury. Measure urine protein and BP, assess hemolysis when indicated, and coordinate drug decisions with oncology and nephrology.

## Separate therapy toxicity from other AKI

Check sepsis, dehydration, obstruction, tumor lysis, and other drugs. A temporal association helps generate a hypothesis but does not establish that chemotherapy caused every creatinine rise.

## Worked comparison

Magnesium loss after cisplatin suggests a tubular problem. Marked proteinuria and hypertension on VEGF inhibition suggests a glomerular/endothelial problem. The second pattern needs more than electrolyte replacement.

## Source lessons

- [chapter 24 updates](https://urinenephrology.org/nephrology-textbook/chapters/chapter-24-updates.html)
- [onconephrology chemotherapy student handout](https://urinenephrology.org/student-resources/toxic-nephropathies/onconephrology-chemotherapy-student-handout.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.