Guidelines for Complications of Cancer Treatment Vol VIII Part B

of methotrexate induced nephropathy includes brisk,diuresis alkalinization of the urine to keep the urinarypH above 7.0 and monitoring serum creatinine andmethotrexate levels (13).6. Bleomycin : Bleomycin does not directly cause renaltoxicity. It is excreted primarily by the kidneys, so doseadjustment is required in the presence of renalinsufficiency or failure.7. Bevacizumab: It may induce nephrotic proteinuria andsevere hypertension If a treated patient develops morethan moderate proteinuria without the nephroticsyndrome, then the drug should be temporarily held asthe proteinuria generally resolves (14).8. Bisphosphonates : Pamidronate and zoledronic acid arecommonly used Both drugs undergo renal excretion.Pamidronate should not be administered in the presenceof severe renal impairment or if the serum creatininerises more than 0.5 mg per dL during treatment (15).Zoledronic acid may be dosed based on CCR (16).Table 1 Chemotherapeutic Drugs not Requiring DoseModification in Renal Failure (17)Actinomycin D Gemcitabine TeniposideAmsacrine Idarubicin 6-ThioguanineBusulfan Melphalan (p.o.) ThiotepaChlorambucil 6-Mercaptopurine VinblastineDaunorubicin Mitoxantrone VincristineDocetaxel Paclitaxel VindesineDoxorubicin Procarbazine Vinorelbine5-Fluorouracil450