Gestion des effets secondaires des thérapies ciblées dans le cancer du rein : effets secondaires néphrologiques

Several types of nephrological side-effects can occur during treatment with targeted therapy: high blood pressure, proteinuria, thrombotic microangiopathy, kidney failure, etc. Screening and treatment for high blood pressure, proteinuria and kidney failure are recommended during treatment with molecular targeted therapy (mainly for anti-VEGF). If BP is greater than 140/90 mmHg on two measurements, it must be treated before the start of treatment. Self-measurement or ambulatory measurement of blood pressure is recommended. All antihypertensive drugs may be used apart from those, which interfere with cytochrome P450 (verapamil and diltiazem). Specialist advice (cardiology or nephrology) is recommended in the event of uncontroled hypertension. It is essential to monitor proteinuria with a urine strip test: if proteinuria is less than 2+ (grade 1), maintain treatment with molecular targeted therapy; if proteinuria is greater or equal to 2+ (grade 2 or 3, confirmed by weight assay), specialist advice is required. Persisting proteinuria of grade 2 or 3 requires nephrological monitoring. Thrombotic microangiopathy must be investigated in the event of hypertension greater than grade 2 and/or proteinuria greater than 2+.