Which of the following anticancer drug causes nephrotoxicity as an adverse effect?
I remember that cisplatin is a well-known platinum-based drug that's associated with nephrotoxicity. It's one of the first drugs that come to mind when thinking about kidney damage. Cisplatin's mechanism of action involves DNA cross-linking, but its toxicity is due to accumulation in the renal tubules. The proximal convoluted tubules are especially affected, leading to acute tubular necrosis. It's important to note that hydration and pre-medications like amifostine are used to mitigate this effect.
Now, looking at other options. Let's say the incorrect options could be drugs like 5-fluorouracil, which is more associated with myelosuppression and mucositis. Vinblastine, a vinca alkaloid, might cause neurotoxicity, not nephrotoxicity. Doxorubicin is known for cardiotoxicity. So if the options include these, they would be incorrect.
The clinical pearl here is that cisplatin's nephrotoxicity is a classic side effect. Students should remember that platinum-based drugs like cisplatin and carboplatin can cause kidney damage, but cisplatin is more notorious for it. Also, monitoring renal function before and during treatment is crucial.
**Core Concept**
Nephrotoxicity is a significant adverse effect of certain chemotherapeutic agents, particularly platinum-based drugs. Cisplatin causes dose-limiting renal damage by inducing oxidative stress and DNA damage in proximal tubular cells.
**Why the Correct Answer is Right**
Cisplatin (Option B) is a platinum-based alkylating agent that forms DNA cross-links, leading to apoptosis. Its nephrotoxicity arises from accumulation in the proximal convoluted tubules, causing acute tubular necrosis. Prehydration with normal saline and diuretics like furosemide are standard preventive measures.
**Why Each Wrong Option is Incorrect**
**Option A:** 5-Fluorouracil primarily causes myelosuppression and mucositis.
**Option C:** Vinblastine, a vinca alkaloid, is associated with neurotoxicity and myelosuppression.
**Option D:** Doxorubicin is notorious for cardiotoxicity, not nephrotoxicity.
**Clinical Pearl / High-Yield Fact**
Cisplatin nephrotoxicity is dose-dependent and reversible with early intervention. Always prehydrate patients and monitor serum creatinine before and during treatment. Contrast this with carboplatin, which has lower nephrotoxic potential.
**Correct Answer: B. Cisplatin**