Figure 531

Toxic therapeutic agents. Nephrotoxicity due to antineoplastic agents may result in chronic renal failure but also may manifest as acute renal failure, specific tubular dysfunction, or the nephrotic syndrome. Nephrotoxicity has been observed with use of alkylating agents, antimetabolites, antitumor antibiotics, and biologic agents, as outlined in the table. These neoplastic agents may induce nephrotoxicity soon after initiation of therapy or only after long-term administration. The risk of nephrotoxicity varies with each agent. This table summarizes the risk of nephrotoxicity, time of onset, and type of functional impairment produced by each agent. (From Massry and Glassock [73]; with permission.)

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