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Does chemotherapy have any impact on kidney function?

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Posted on Fri, 29 May 2015
Question: My father-in-law is currently undergoing chemotherapy. He supposed to do 8 cycles of Capecitabine and currently on cycle 6. The Oncologist's summary of his colon tumor surgery (last November) attached. Also attached the blood test results after the cycle 4 and cycle 5. The oncologist has been reducing his drugs and also extend the rest period (now 2 weeks in between cycles) due to his reaction to chemo which including feet sore/burning, skin darkening, tongue blisters, loose stool (not to the level of diarrhea yet), dry/cracking skin on hands... In the most recent visit (post cycle 5), the doctor suggested him to take 10 days and skip the last 2 days if he doesn't feel good.

I hope you could help with 2 questions:
1). his UREA level has been high, and has been rising from April to May even though his drug level is quite low and he is having a 2 weeks rest in between cycles). Does this high level leads to concerns of his kidney function? will the chemo has any impact on this?

2). His ERCS, HGB and HCT levels has been constantly low. He has anemia problem since his colon tumor was discovered but didn't seem to get better even after the surgery. Before years before that, his medical exam never showed any issue on this front. Does more tests need to be done on him to find out the true cause? such as Thyroid function, etc? is there medication can help? Can he take some natural supplement such as iron water? his diet is very good and has no shortage of food that contains iron.

Thanks!

doctor
Answered by Dr. Ivo Ditah (34 minutes later)
Brief Answer:
Most chemotherapy drugs suppress the bone marrow cells!

Detailed Answer:
Hi and thank you so much for this query.

I am so sorry to hear about this cancer that you father had. I have reviewed his information fully and have reviewed the attached reports as well. I understand how much stress you could be going through now. I encourage you to be happy because the doctors seem to be doing all in their capacity given the best available up to date options to address this. I wish your dad the best of all possible outcomes.

1. Increasing urea reflects kidney function, However, creatinine is what tells us whether the kidneys have been damaged or not as they are stable over time whereas BUN fluctuates a lot. Though most chemotherapy drugs are toxic to the kidney, his numbers are pretty good and there is no reason to panic at this time and with creatinine still being in the normal range. We simply need to continue monitoring this to make sure we do not miss out on some other concerning ongoing disease condition.

2. Chemotherapy drugs are meant to suppress the multiplication of and kill cancer cells. Unfortunately, this also happens to the cells that produce red blood cells, white blood cells and platelets. This is the reason why these numbers have been consistently low or getting lower throughout this process of chemotherapy. The problem is not iron intake but a well known and recognized side effects of the chemotherapy. They would greatly improve after he's done with the chemotherapy. This is not caused by a thyroid disease and exploring further might not be helpful at this time as most of this can be explained by the cancer and chemotherapy.

I strongly recommend against herbs. Please. no one has certified their safety and beneficial effects and I will not want you to carry out the experiment yourself with no control. I say NO to this.

I hope this helps. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ivo Ditah (6 hours later)
Thank you Dr Ditah! Really appreciate your thorough response! Very very helpful...
Dr. Ditah, one more question - for the anemia, at what point (i.e. what level ERCS, HGB, HCT etc) that he may need a blood transfusion? basically, are his current levels concerning and need to take some actions or it's still mild and we just need to keep monitoring them?

He was very very pale on his face/hands before his surgery and the hospital did transfusion at that time. Now because his skin is dark (quite black) due to the chemo, it's hard for us to tell!

thanks a lot!
doctor
Answered by Dr. Ivo Ditah (31 hours later)
Brief Answer:
I will not recommend transfusion at this time.

Detailed Answer:
Hi and thanks for this follow up precision.

I have reviewed this information fully. Because this is a chronic anemia, he can tolerate it better and even numbers which seem low would not necessarily require transfusion. Transfusion goes with so much risk that I would not want to recommend it unless there is no other way out.

For now, I recommend healthy diet. If the levels fall below 7 or he is extremely short of breath, then transfusion would be considered.

I wish you well.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Ivo Ditah (11 minutes later)
Dr. Ditah, sorry, one quick clarification. which test you refer to when you mentioned "if the level fall below 7"? is it the RDW?
thanks again!
XXXX
doctor
Answered by Dr. Ivo Ditah (1 minute later)
Brief Answer:
Hemoglobin!

Detailed Answer:
Hi,

I am referring to Hemoglobin levels. Thanks and let me know if you have any further worries that need to be addressed. I am always available and ready to assist.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Ivo Ditah (1 hour later)
I see. Thanks a lot!
XXXX
doctor
Answered by Dr. Ivo Ditah (1 hour later)
Brief Answer:
You are welcome!

Detailed Answer:
Hi,

Anytime you need help, am right here. Feel free talking to me. Thanks.


Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Ivo Ditah

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Practicing since :2002

Answered : 3993 Questions

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Does chemotherapy have any impact on kidney function?

Brief Answer: Most chemotherapy drugs suppress the bone marrow cells! Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about this cancer that you father had. I have reviewed his information fully and have reviewed the attached reports as well. I understand how much stress you could be going through now. I encourage you to be happy because the doctors seem to be doing all in their capacity given the best available up to date options to address this. I wish your dad the best of all possible outcomes. 1. Increasing urea reflects kidney function, However, creatinine is what tells us whether the kidneys have been damaged or not as they are stable over time whereas BUN fluctuates a lot. Though most chemotherapy drugs are toxic to the kidney, his numbers are pretty good and there is no reason to panic at this time and with creatinine still being in the normal range. We simply need to continue monitoring this to make sure we do not miss out on some other concerning ongoing disease condition. 2. Chemotherapy drugs are meant to suppress the multiplication of and kill cancer cells. Unfortunately, this also happens to the cells that produce red blood cells, white blood cells and platelets. This is the reason why these numbers have been consistently low or getting lower throughout this process of chemotherapy. The problem is not iron intake but a well known and recognized side effects of the chemotherapy. They would greatly improve after he's done with the chemotherapy. This is not caused by a thyroid disease and exploring further might not be helpful at this time as most of this can be explained by the cancer and chemotherapy. I strongly recommend against herbs. Please. no one has certified their safety and beneficial effects and I will not want you to carry out the experiment yourself with no control. I say NO to this. I hope this helps. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.