title: The ability of mannitol to decrease cisplatin-induced nephrotoxicity in children: real or not?
abstract: OBJECTIVE
  Platinum compounds are very effective drugs for the treatment of childhood malignancies, and their use has contributed to an increase in the long-term survival of children with cancer. Unfortunately, the risk of severe disabling effects such as nephrotoxicity is well known among children receiving cisplatin-based chemotherapy.
  
  
  METHODS
  The main pharmacodynamics and clinical characteristics of cisplatin nephrotoxicity are described in order to explore the real ability of mannitol to prevent cisplatin-related nephrotoxicity.
  
  
  RESULTS
  Currently, the choice of hydration alone or hydration plus mannitol to prevent nephrotoxicity is controversial. No guidelines are available to provide recommendations on this issue either in adults or in children.
  
  
  CONCLUSIONS
  Appropriate hydration remains the main fundamental strategy for reducing the risk of cisplatin-induced nephrotoxicity. In conventional treatment regimens employing doses of cisplatin of less than 100 mg/m(2) in patients with normal renal function, pre- and post-hydration (3 l/m(2) at least 12 h pre-cisplatin and 24 h post-cisplatin) alone should be routinely used. In higher doses, pre- and post-hydration plus mannitol should be considered in order to ensure a valid diuresis.
authors.affiliation: Division of Pediatric Oncology, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy. ruggiero@rm.unicatt.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ruggiero
authors.affiliation: Division of Pediatric Oncology, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Rizzo
authors.affiliation: Division of Pediatric Oncology, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Trombatore
authors.affiliation: Division of Pediatric Oncology, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy.
authors.forename: Palma
authors.initials: P
authors.lastname: Maurizi
authors.affiliation: Division of Pediatric Oncology, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Riccardi
mesh_terms: D000328:Adult; D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002945:Cisplatin / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D008353:Mannitol / Q000627:therapeutic use*; D020011:Protective Agents / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D020011:Protective Agents; D008353:Mannitol; D002945:Cisplatin
keywords: Children; Cisplatin; Hydration; Mannitol; Nephrotoxicity