Table 17. Kidney and Bladder Late Effects
| Predisposing Therapy | Renal/Genitourinary Effects | Health Screening |
| BUN = blood urea nitrogen; NSAIDs = nonsteroidal anti-inflammatory drugs; RBC/HFP = red blood cells per high-field power (microscopic exam). | ||
| Cyclophosphamide/Ifosfamide; radiation impacting bladder/urinary tract | Bladder toxicity (hemorrhagic cystitis, bladder fibrosis, dysfunctional voiding, vesicoureteral reflux, hydronephrosis) | History: hematuria, urinary urgency/frequency, urinary incontinence/retention, dysuria, nocturia, abnormal urinary stream |
| Urinalysis | ||
| Urine culture, spot urine calcium/creatinine ratio, and ultrasound of kidneys and bladder for patients with microscopic hematuria (defined as ≥5 RBC/HFP on at least 2 occasions) | ||
| Nephrology or urology referral for patients with culture-negative microscopic hematuria AND abnormal ultrasound and/or abnormal calcium/creatinine ratio | ||
| Urology referral for patients with culture negative macroscopic hematuria | ||
| Cisplatin/carboplatin; ifosfamide | Renal toxicity (glomerular injury, tubular injury [renal tubular acidosis], Fanconi syndrome, hypophosphatemic rickets) | Blood pressure |
| BUN, Creatinine, Na, K, Cl, CO2, Ca, Mg, PO4 levels | ||
| Urinalysis | ||
| Electrolyte supplements for patients with persistent electrolyte wasting | ||
| Nephrology consultation for patients with hypertension, proteinuria, or progressive renal insufficiency | ||
| Methotrexate; radiation impacting kidneys/urinary tract | Renal toxicity (renal insufficiency, hypertension) | Blood pressure |
| BUN, Creatinine, Na, K, Cl, CO2, Ca, Mg, PO4 levels | ||
| Urinalysis | ||
| Nephrology consultation for patients with hypertension, proteinuria, or progressive renal insufficiency | ||
| Nephrectomy | Renal toxicity (proteinuria, hyperfiltration, renal insufficiency) | Blood pressure |
| BUN, Creatinine, Na, K, Cl, CO2, Ca, Mg, PO4 levels | ||
| Urinalysis | ||
| Discuss contact sports, bicycle safety (e.g., avoiding handlebar injuries), and proper use of seatbelts (i.e., wearing lapbelts around hips, not waist) | ||
| Counsel to use NSAIDs with caution | ||
| Nephrology consultation for patients with hypertension, proteinuria, or progressive renal insufficiency | ||
| Nephrectomy; pelvic surgery; cystectomy | Hydrocele | Testicular exam |
| Cystectomy | Cystectomy-related complications (chronic urinary tract infections, renal dysfunction, vesicoureteral reflux, hydronephrosis, reservoir calculi, spontaneous neobladder perforation, vitamin B12/folate/carotene deficiency [patients with ileal enterocystoplasty only]) | Urology evaluation |
| Vitamin B12 level | ||
| Pelvic surgery; cystectomy | Urinary incontinence; urinary tract obstruction | History: hematuria, urinary urgency/frequency, urinary incontinence/retention, dysuria, nocturia, abnormal urinary stream |
| Counsel regarding adequate fluid intake, regular voiding, seeking medical attention for symptoms of voiding dysfunction or urinary tract infection, compliance with recommended bladder catheterization regimen | ||
| Urologic consultation for patients with dysfunctional voiding or recurrent urinary tract infections | ||
