title: Ifosfamide nephrotoxicity in children: a mechanistic base for pharmacological prevention.
abstract: The antineoplastic drug ifosfamide (IFO) in the treatment of solid tumors, particularly in children, is the cause of severe nephrotoxicity. Although it is a potent and effective chemotherapeutic agent, the associated nephrotoxicity has a serious impact on the health and the quality of life of exposed children. The toxic metabolite of IFO thought to be responsible for IFO-induced kidney damage is chloroacetaldehyde (CAA). Those suffering from nephrotoxicity typically develop tubular and glomerular toxicities, with the most severe form being Fanconi's syndrome. As the mode of toxicity of CAA seems to be primarily owing to oxidative stress, the use of antioxidants as a protective measure for the kidneys is a promising strategy. In this review, we highlight recent research that supports the local renal production of CAA as the proximate cause of IFO-induced nephrotoxicity with age as an important risk factor, those under the age of three being the most vulnerable. Most importantly, we focus on the potential advantages of the antioxidant N-acetylcysteine owing to both its antioxidant properties and its current use clinically in pediatrics.
authors.affiliation: Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hanly
authors.forename: Nancy
authors.initials: N
authors.lastname: Chen
authors.forename: Michael
authors.initials: M
authors.lastname: Rieder
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D000079:Acetaldehyde / Q000009:adverse effects / Q000031:analogs & derivatives*; D000111:Acetylcysteine / Q000627:therapeutic use*; D000367:Age Factors; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000494:pharmacology; D000975:Antioxidants / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects* / Q000494:pharmacology; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control; D018384:Oxidative Stress / Q000187:drug effects; D012307:Risk Factors
chemical_list: D018906:Antineoplastic Agents, Alkylating; D000975:Antioxidants; C004656:chloroacetaldehyde; D000079:Acetaldehyde; D007069:Ifosfamide; D000111:Acetylcysteine