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The renal toxicity of anticancer drugs is a clinical challenge because of the intrinsic toxicity of some anticancer drugs and because the cancer itself. Indeed, cancer patients are exposed to all types of renal disorders (obstructive, functional, organic because of radiotherapy, paraneoplastic glomerulopathy, thrombotic microangiopathy…). The therapeutic index of anticancer drugs is often narrow and the doses used for optimal efficacy are high. Improving safety requires a better dose adjustment, which depends on the correct evaluation of the renal function. Prevention remains important as the mortality associated with acute renal failure is very high., (Copyright © 2021. Published by Elsevier Masson SAS.)

Introduction: The French National Authority for health recommends that the adjustment of the dosage of drugs in patients with renal insufficiency be carried out on the basis of an estimate of renal function using the Cockcroft-Gault formula, while the estimation of the glomerular filtration rate using the Modification of Diet in Renal Disease or CKD-EPI formula is recommended for the diagnosis and monitoring of renal insufficiency. The argument put forward is that the recommendations for dosage adjustment of the summaries of product characteristics would have been established on the basis of the use of this formula. Service ICAR aimed at verifying the evidence supporting this argument., Methods: In all, 2447 summaries of product characteristics were analyzed to identify the renal function criterion specified for dose adjustment recommendations. When no formulas were found in the summary of product characteristics, the firms were contacted to obtain information on renal function estimation methods used in developmental studies. Their responses were analyzed., Results: Of the 2447 summaries of product characteristics studied, 438 (17.9%) propose a dosage adjustment in case of renal insufficiency. No formula is mentioned in the summarie of product characteristics for 90.0% of them. The Cockcroft-Gault and Modification of Diet in Renal Disease/CKD-EPI formulas are found in 8.7% and 0.7% respectively of these 438 summaries of product characteristics. After contacting pharmaceutical companies and analysis of the data available in the studies on which the summaries of product characteristics were based, the information cannot be found for 63.0% of the summaries of product characteristics, in spite they mention the need to adjust the dosage in case of renal insufficiency., Conclusion: The majority of summaries of product characteristics do not mention the Cockcroft-Gault formula and in the majority of cases it is not possible to identify the formula or technique used in the studies on which is based the reference to dosage adjustment in the summarie of product characteristics. In addition, there are discrepancies between the wording of the summaries of product characteristics and the data from development studies. The use of Cockcroft-Gault for dosage adjustment is to be questioned, especially since the Isotope-dilution mass spectrometry, or IDMS, standardization of creatinine dosage makes obsolete studies based on Cockcroft-Gault formula and a non-standardized dosage, and thus the use of Cockcroft-Gault not transposable to current clinical practice., (Copyright © 2019 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Background: Calciphylaxis or calcific uremic arteriolopathy (CUA) is a cutaneous disease with ulcerations secondary to calcification of cutaneous and subcutaneous small arteries and arterioles. It is a rare but severe disease with significant morbidity and mortality affecting 1 to 4% of dialysis patients. The circumstances of occurrence are multiple., Case: We report the case of a severe bilateral lower limb calciphylaxis in a 69-year-old, obese, hemodialysis patient with a recent diagnosis of Graves' disease complicated with hypercalcemia and cardiac arrhythmia requiring the use of vitamin K antagonist. Complex and multidisciplinary therapeutic management (daily hemodialysis, sodium thiosulfate therapy, treatment of hypercalcemia by denosumab, hyperbaric oxygen therapy, meshed skin autograft) allowed complete healing of the lesions., Conclusion: This is the first description of AUC secondary to hyperthyroidism in a dialysis patient. Multidisciplinary care is essential to achieve clinical improvement in those critical situations., (Copyright © 2018 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.)

The development of interventional radiology techniques regularly exposes patients to the potential renal toxocity of iodinated contrast media. Faced with this risk of nephrotoxicity, gadolinium-based contrast agents have long been considered as a safe alternative to iodinated contrast media, especially in sensitive or at risk patients. However, these gadolinium-based contrast agents are not devoid of nephrotoxicity and present another risk, a complication related to renal failure, the nephrogenic systemic fibrosis. European and US recommendations from health agencies have recently come closer, defining groups of patients at risk of nephrogenic systemic fibrosis according to their level of renal function and the type of gadolinium-based contrast agent used. What are the real renal risks for these products? How to evaluate the benefit-risk balance of the patient to choose a radiological examination in an informative, effective and safe way? This article focuses on the description of the risks of gadolinium-based contrast agents, reviews existing recommendations and best practices to guide the choice of clinicians., (Copyright © 2018. Published by Elsevier Masson SAS.)

Rationale: The impact of chronic kidney disease (CKD) on vital impetus is poorly documented in patients not undergoing renal dialysis and discrepancies can be observed between patients and physicians in perception of QoL and impact of the disease., Methods: A self-questionnaire was sent to 1282 French nephrologists and a mirrored self-questionnaire was given to patients (CKD stage 3, 4 or 5) by their nephrologist. Data were collected prospectively and anonymously., Results: A total of 261 nephrologists and 172 patients participated in the survey. Sixty-six percent of patients reported a negative impact of the disease on their quality of life, which is also identified by nephrologists: important impact 22% vs 27%, mild or inconstant 44% vs 47%, mild or absent 34% vs 31% in patients and nephrologists, respectively. They had different perceptions about factors contributing to vital force; in particular, nephrologists underestimated their key role in psychological support. Indeed, the optimism and encouragements of nephrologists were considered to be a key factor of vital force for 60% of patients vs 20% of nephrologists (P<0,001). During consultations, nephrologists were primarily focused on biological abnormalities and adherence to treatment while mood or sexual disorders were rarely investigated. The main objective of treatment was to maintain a normal life for patients and to delay dialysis for nephrologists., Conclusion: Nephrologists have a relative knowledge of CKD impact on the vital impetus of patients, but there are differences of perception. It could be improved through specific trainings., (Copyright © 2017 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Assumed for a long time to be very well tolerated, proton pump inhibitors (PPIs) are widely prescribed for inpatients and outpatients; often beyond their validated indications. Nevertheless, many very varied side effects (pneumopathy, ischemic heart disease, dementia) have been associated with the PPIs during the last decade. Renal toxicity is mainly the occurrence of acute interstitial nephritis (AIN), related to a drug-class effect, involving cellular immunity. AINs, which occur especially in elderly patients, can be difficult to diagnose, with frequently isolated acute kidney injury, appearing with variable delay after the introduction of PPIs. Although sensitive to steroid therapy, patients frequently have an incomplete recovery of the kidney function. Very recently, the risk of chronic kidney disease (CKD) and the risk of progression of CKD among PPIs users have been well demonstrated in several large independent epidemiological studies. It is a low, but a significant side effect because of the millions of PPI prescriptions. Although further studies are needed to investigate the pathophysiological mechanisms leading the use of PPI to CKD, it is appropriate for the physicians to limit PPIs to their correct indications and to monitor renal function during these treatments., (Copyright © 2017 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.)

The remarkable improvement of the outcome of HIV infection came with the price of substantial toxicity of some antiretrovirals. The first molecules used to treat HIV included an important nephrotoxicity. Zalcitabine, stavudine and didanosine can induce severe lactic acidosis. Lactate production is enhanced and the renal capacity to regulate pH is overwhelmed. However, this side effect is not due to a direct dysfunction of the kidneys. Zalcitabine was withdrawn from the market because of this risk. Indinavir, a protease inhibitor, is soluble only in very acidic solutions. Consequently, the small fraction that is excreted in the urine precipitates and can be responsible for uro-nephrolithiasis, leukocyturia, cristalluria, obstructive acute kidney failure, and acute or chronic interstitial nephritis. This is the reason why indinavir is almost not prescribed nowadays, even if it is still marketed. In addition to the direct nephrotoxicity of some antiretrovirals, anti-HIV treatment also includes a toxicity which pathophysiology is not completely elucidated. This nephrotoxicity is the consequence of organ accelerated ageing and of an increased vascular risk. Kidney vascularization (from renal arteries to capillaries) is essential to kidney function and all cardiovascular risks are also renal risks. It is now clearly established that combined antiretroviral treatment increases the vascular risk. A better comprehension of the links between HIV infection, its treatment and very long-term kidney risk is needed to improve the complex management of patients who have now cumulated several decades of HIV infection and treatment with various toxicities., (Copyright © 2017 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Acute renal failure (ARF) in adults in the intensive care unit (ICU) often evolves in a context of multiple organ failure, which explains the high mortality rate and increase treatment needs. Among, two modalities of renal replacement therapy, peritoneal dialysis (PD) was the first modality used for the treatment of ARF in the 1950s. Today, while PD is generalized for chronic renal failure treatment, its use in the ICU is limited, particularly, due to the advent of new hemodialysis techniques and the development of continuous replacement therapy. Recently, a renewed interest in the use of PD in patients with ARF has manifested in several emerging countries (Brazil, Vietnam). A systematic review in 2013 showed a similar mortality in ARF patients having PD (58%) and those treated by hemodialysis or hemodiafiltration/hemofiltration (56.1%). In the International society of peritoneal dialysis (ISPD)'s guideline (2013), PD may be used in adult ARF as the other blood extracorporeal epuration technics (recommendation with grade 1B). PD is the preferred method in cardiorenal syndromes, in frailty patients with hemodynamic instability and those lacking vascular access; finally PD is also an option in elderly and patients with bleeding tendency. In industrial countries, high volume automated PD with a flexible catheter (usually Tenckhoff) is advocated., (Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Tenofovir is currently the only commercially available nucleotidic reverse-transcriptase inhibitor of human immunodeficiency virus (HIV). It is overall very well tolerated and is prescribed to millions of patients-without any specific monitoring in developing countries. However a significant nephrotoxicity has been described. Acute nephrotoxicity is well characterized. Tenofovir is excreted in urine by proximal tubular epithelial cells. In case of cytoplasmic accumulation, tenofovir inhibits mitochondrial DNA polymerase γ, which causes a dysfunction of the respiratory chain, and in turn an alteration of the energy-deprived cells. Fanconi syndrome is the clinical expression of tenofovir acute toxicity, with sometimes an associated acute kidney failure. These abnormalities are usually reversible, at least partially, when tenofovir is discontinued. Tenofovir chronic toxicity has been debated but seems now well established by several cohort studies, even though it pathophysiology has yet to be understood. It manifests as an accelerated glomerular filtration rate decline in treated patients with no other renal abnormalities. The identification of this chronic toxicity was probably blurred by multiple cofactors, usually excluded from clinical trials. Simple measures such as dose adaptation to kidney function, identification of risk factors, and plasmatic tenofovir concentration monitoring can help decrease the risk of nephrotoxicity., (Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Thyroid hormones influence renal development, kidney structure, renal hemodynamics, glomerular filtration rate, the function of many transport systems along the nephron, and sodium and water homeostasis. Effects of hypothyroidism and hyperthyroidism on kidney function are the result of direct renal effects, as well as systemic hemodynamic, metabolic, and cardiovascular effects. Most of the renal manifestations of thyroid disorders, which are clinically most significant with hypothyroidism, are reversible with treatment. Patients with hypothyroidism can have clinically important reductions in GFR, so screening for hypothyroidism should be considered in patients with unexplained elevations in serum creatinine. Patients with thyroid disorders are also at risk for immune-mediated glomerular diseases. Finally, patients with nephrotic syndrome, as well as acute and chronic kidney injury, have alterations in thyroid gland physiology that can impact thyroid function and the testing of thyroid function status. Dialysis patients have frequently hypothyroidism whose biological diagnosis must be careful., (Copyright © 2012 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Drug-induced renal dysfunction is frequent in clinical practice. Outcomes may be severe, with increased morbidity and mortality. Kidneys are particularly vulnerable to drug toxicity, especially since they are highly vascularized, thus receiving about 25% of cardiac output. Furthermore, interstitial accumulation of toxic agents in papilla and the medulla often occurs due to the existence of a corticomedullary osmotic gradient. Moreover, the key role played by the renal tubule in the reabsorption processes of a number of endogenous and exogenous substances further increases the exposure of the kidney to high concentrations of potentially toxic agents, both in the tubular lumen and cells. As a result, drugs may be toxic to all of the four structures of the kidney: glomerulus, tubule, interstitium, and blood vessels. This chapter reviews the main mechanisms of drug-induced renal toxicity and then focuses on the nephrotoxicity of anti-infectious drugs: antibacterial drugs, antifungal agents, antimalariae, and antiviral drugs. NSAID and anticancer drugs renal toxicity are detailed elsewhere in this textbook. Methods used to prevent drug-induced nephrotoxicity, when known, are detailed. Risk factors are also listed, such as high-risk populations, identification and elimination of risk factors, and drug dosage adjustment in patients with baseline abnormal renal function.

A patient is admitted in hospital to explore a nephrotic proteinuria associated with milky urine. This is explained by a chyluria (presence of lymphatic fluid in the urines), which is due to a pyelolymphatic fistula probably linked to a lymphatic filariasis. Usually, the diagnosis of chyluria can be confirmed by the presence of urinary chylomicrons. The presence of an urinary-lymphatic fistula can be proved by different techniques (cystoscopy, retrograde pyelography, uroscanner, lymphoscintigraphy). The main cause of chyluria is parasitic infections (filarial infection, echinococcus, cysticercosis), but other causes can be found, such as granulomatosis, neoplasia, lymphatic malformations, or sequela of surgery or traumatism. Chyluria is one of the causes of post-nephronic nephrotic proteinuria. Depending on the impact of the chyluria for the patient, there will either be no treatment, or a treatment by sclerotherapy or surgery.

HIV infection has become a global disease, both in geographic terms, since it has spread worldwide, and at the individual level since it affects every organ of the human body. Antiretroviral treatments, in countries where they are easily available, have modified HIV infection into a systemic chronic disease, the life expectancy of which is yet to be determined precisely. Treatments have dramatically changed the pattern of the disease and clinicians now have to face a number of new challenges. Kidneys, like all the other organs, can be involved in a great number of diseases in HIV-infected patients. We have voluntarily chosen to present "kidney diseases in HIV-infected patients" in their wider meaning, with a discussion of renal diseases that are directly caused by the virus, nephropathies due to frequent viral co-infections in HIV-infected patients such as HCV and HBV, nephropathies induced by anti-HIV, HBV and HCV therapies. Physicians in charge of HIV-infected patients should be aware of the key role they have to play in the screening for kidney abnormalities. This participates not only in improving patients' kidney prognosis but also their long-term general outcome. Renal screening strategies must refer to simple routine laboratory tests. Enclosed at the end of this article are a few suggestions for the renal management of situations that frequently occur in HIV infected patients (kidney dysfunction screening, serum creatinine increase and discovery of a proteinuria).

The European patents for epoetin alpha recently expired. Biosimilars (i.e. "a medicine which is similar to a biological medicine that has already been authorized" [EMEA 2007]) of epoetins have thus been released on the market in Europe. Because of the complexity of the processes that are required to produce medicinal products containing biotechnology-derived proteins as active substances and to characterize the physicochemical properties of these compounds, the guidelines that have been developed for generic drugs cannot be used for approval of biosimilar products. The EMEA guidelines do not answer all questions that have been raised for the development of biosimilars, and in some cases, decisions will have to be taken at a national level. This is why the Society of Nephrology (Société de néphrologie), the French-speaking Society of Dialysis (Société francophone de dialyse) and the Pediatric Society of Nephrology (Société de néphrologie pédiatrique) established guidelines for the usage of biosimilar epoetins concerning approval, identification, substitution of an innovator drug, post-marketing surveillance, extension of indication and pharmacovigilance plan.

The management of anemia after kidney transplantation remains poorly explored. The Management of Anemia in French Kidney Transplant Patients (MATRIX) study is an observational study conducted in 10 academic hospitals among kidney-transplant patients designed to evaluate the prevalence, associated factors and management of post-transplant anemia. Over two consecutive weeks, 418 recipients (males: 248; age: 50.8+/-12.7 years) were included, all were transplanted for more than six months. Mean serum creatinine (Scr) was 152+/-67 micromol/l and mean hemoglobin (Hb) was 12.4+/-1.8 g/dl (males: 12.8+/-1.9 g/dl; females 11.9+/-1.6 g/dl). Irrespective of the delay following transplantation, 23% of patients (n=95) were severely anemic (Hb < or = 11 g/dl). Eighteen percent of the patients received an antianemic treatment (10% oral iron, 7% erythropoiesis stimulating agents (ESA), 4% folic acid) and only 35% of the severely anemic patients were actually treated (n=33). A significantly-negative correlation was observed between eGFR and Hb levels (R= -0.347, p<0.02). Ninety-six percent of the 193 patients transplanted for more than six months and a Scr greater than 150 micromol/l (n=185) suffered at least one comorbidity (89% hypertension, 32% hypercholesterolemia, 13% diabetes); this group represent the second cohort. Seventy-four percent of them were treated with mycophenolate mofetil, 16% with azathioprine, and 62% with an ACEI or angiotensin II receptor antagonists. Since the transplantation, 127 patients (66%) have been anemic (Hb < or = 11 g/dl) and 58% (n=112) were treated (iron and/or ESA, respectively 81 and 55%). Among the patients not treated for anemia, 74% had an Hb level below 12g/dl. ESA-treated patients received a mean dose of 8500 UI+/-2800 per week. Anemia is under-diagnosed and under-treated in renal-transplant recipients, despite its high prevalence. As expected, a correlation between renal function and Hb levels was observed, as in CKD patients. Prospective studies are underway to assess the consequences of postkidney transplant anemia on quality of life, cardiovascular morbidity and chronic allograft nephropathy and to define the benefit of the treatment.

Angiogenesis inhibitor drugs (bevacizumab, sunitinib, sorafénib...) are now widely used for treatment of cancers, including colorectal, advanced renal cell and hepatocellular carcinomas, breast cancer). Vascular and renal side-effects of these drugs are not well known. Hypertension is one of the most common side effects. Incidence of hypertension may be different among angiogenis inhibitors and seems dose-depend. Arterial pressure can usually be controlled with anti-hypertensive medications, and treatment with angiogenesis inhibitors can be continued in most cases; however, serious hypertension-induced side effects were reported included malignant hypertension, stroke and reversible posterior leucoencephalopathy. Renal damage is infrequently reported: usually reversible mild or moderate proteinuria and in some rare cases nephritic syndrome, acute renal dysfunction, proliferative or collapsing glomerulonephritis, interstitial nephritis and thrombotic microangiopathy. Prolongation of the QT interval, congestive heart failure and left ventricular dysfunction have been reported in patients using tinibs. In the present guidelines, we recommend: (1) before the first administration of angiogenesis inhibitors: acute IV or oral antihypertensive medications should not be administered in a patient regardless of arterial pressure levels with postponing the administration because of hypertension is not recommended; (2) initial work-up should include ambulatory measurement of arterial pressure (by the general practitioner or by the patient using home blood pressure (three times in the morning and in the evening during three consecutive days) with a validated (cf: http://afssaps.sante.fr/) upper arm device: ideally, this device should be financed and provided by the pharmaceutical companies marketing the angiogenesis inhibitor drugs. Using 24-hour ambulatory blood pressure measurement is optional; (3) urine dipstick (and quantification if positive) and estimated glomerular filtration rate (using abbreviated MDRD rather than Cockcroft-Gault formula) must be performed before treatment and regularly during follow-up; (4) therapeutic management must be done in accordance with national or international guidelines (in France: http://www.has-sante.fr/); (5) optimal care is best achieved within a network of professionals including general practitioners, oncologists, cardiologists and nephrologists.

Several recent articles have examined the time-dependent effects of epoetin therapy and the variability of hemoglobin (HGb) levels and what epoetin does in hemodialysis patients. A recent preliminary report also found that HGG cycling was common among hemodialysis patients, with only 10% of patients remaining within their initial HGb range (less than 11 g/dl, 11 to 12.5 g/dl, greater than 12.5 g/dl) during a six-month period. Factors associated with HGb cycling were changes in epoetin dose, intravenous-iron administration or a change in dose and hospitalization. What is not known is whether there are adverse clinical outcomes associated with HGb variability, although preliminary data indicate, perhaps predictably, that a decreasing HGb level is associated with a higher mortality risk. This is certainly an area that merits further study.

Prevalence of chronic renal disease increases in France and in the world mainly because of ageing and diabetes mellitus. Early diagnosis and treatment of chronic renal disease allows significant slowing of the speed of degradation of glomerular filtration rate and may postpone or alleviate initiation of dialysis, an expensive and time consuming therapy. For the first time in France in October 2005, a campaign of information to improve awareness of French citizens on renal diseases was organised. A survey was conducted by BVA in a sample of the French population to evaluate their degree of knowledge on renal diseases. Our study showed that French citizens do not know much about anatomical and physiological considerations concerning their kidneys. They are not aware of symptoms revealing renal disease or therapy available in case of kidney failure. Almost one third of the persons interviewed are directly or indirectly touched by renal diseases. It seems that efforts should be made to better information of French citizens on renal diseases as a first step towards improvement of chronic renal failure treatment strategy.

Targets for anaemia treatment have been largely evaluated. A target > 11 g/dL is currently recommended. High target (13-14 g/dl) is contraindicated in patients with cardio-vascular disease. In patients without cardiovascular disease, a target of 13-14 g/dl could bring an improvement in some symptoms of quality of life. In hemodialysis patients, a high target decreases the dialysis efficiency, increases the risk of clotting into the dialysis circuit and increase the risk of vascular access thrombosis, in particular in case of graft.

In all countries, the number of diabetic patients with end stage renal disease is growing. The question is whether this mode of therapy is the most appropriate for uremic diabetics. The superiority of any type replacement renal therapy (RRT) over another cannot be unequivocally proven in the absence of a truly random long-term prospective study, which for obvious reasons, has not and probably will not be carried out. Today, the decision on the final choice is indeed dependant on patient preferences, medical factors, physician's biais, local facilities and financial aspects. If in most centers, survival analysis results performed in Europe and in North America regarding diabetic patients RRT are conflicting, the interpretation of comparisons of survival rates published in different studies must be treated with great caution. Nevertheless, if diabetic patients survival is significantly lower than that of non diabetic patients independently of the technique chosen there is no argument to assess that survival at 2 years of diabetic patients aged less 55 years is better on PD than on HD. There is no argument to assess that survival at 2 years of diabetic patients aged more 55 years is better or less appropriate on PD than on HD, excepted in the North America where survival seems to be less appropriate on PD. The present report summarizes the major advantages and drawbacks of the PD method in insulin treated diabetic patients.

Adefovir is transported by the organic anion transporter (OAT1) and the multidrug resistant protein (MRP2, 4 and 5). We studied adefovir clearance in rat after inhibition of transporters by probenecid and in TR- rats, in which MRP2 is lacking. After treatment by probenecid or placebo, pharmacokinetics of adefovir 10 mg/kg was studied via population modeling (NONMEM). The fraction of drug excreted in the urine was low. Renal clearance of adefovir was significantly lower (P < 0.05) in probenecid TR- rats (0.03 +/- 0.02 l/hour) than in normal control (0.09 +/- 0.05 l/hour), in normal probenecid (0.10 +/- 0.07 l/hour) and in TR- control rats (0.13 +/- 0.07 l/hour). In vivo in rats MRP2 mutation alone did not affect adefovir clearance suggesting that MRP2 does not play a critical role in the secretion of adefovir. Additional pharmacological inhibition of transporters decreased renal clearance, which may reflect inhibition of compensating transport mechanisms activated when MRP2 is lacking.

Drug-induced kidney injury is a major side effect in clinical practice. Renal injury associated with drugs may involve several components of the kidney: glomerulus, tubules, interstitium and blood vessels. Acute renal failure may occur as a major reaction to many drugs. Moreover, therapeutic agents may induce an allergic reaction leading to interstitial inflammation and tubular damage. In this article, we present an updated version of the bibliography containing the case reports of nephrotoxicity published in the international literature from January 2003 to December 2004.

Nephrotoxicity is an inherent adverse effect of certain anticancer drugs. Anti neoplasic drugs have a narrow therapeutic index and the amount of drug necessary to produce a significant reduction in tumour burden usually produces significant nephrotoxicity. The dosage used in clinical trials represents often the maximum tolerated doses determined during phase I drug evaluation. Greater toxicity is acceptable during curative therapy than during palliative therapy. But cancer patients often exhibit excretory reduced organ function. Modulation of pharmacokinetics and pharmacodynamics of these drugs in cancer patients is therefore necessary in order to improve tolerance. Patients with malignancies are particularly vulnerable to development of renal abnormalities. Conversely, patients with renal abnormalities who have undergone kidney transplantation are at high risk for malignancy. Clinical syndromes of renal involvement are diverse and sometimes insidious. Despite the recent advances in understanding the mechanism of anticancer drug nephrotoxicity, prevention still relies on drug dosage decrease and active screening for renal abnormalities as part of the usual biological work up in patients treated with anticancer drugs.