Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
Kidney
Certain types of chemotherapy increase the risk of kidney late effects.
The risk of health problems that affect the kidney increases after treatment with the following:
- Chemotherapy including cisplatin, carboplatin, ifosfamide, and methotrexate.
- Radiation therapy to the abdomen or middle of the back.
- Surgery to remove part or all of a kidney.
- Stem cell transplant.
The risk of kidney late effects is greater in childhood cancer survivors who are treated with a combination of surgery, chemotherapy, and/or radiation therapy.
The following may also increase the risk of kidney late effects:
- Having cancer in both kidneys.
- Having a genetic syndrome that increases the risk of kidney problems, such as Denys-Drash syndrome or WAGR syndrome.
- Being treated with more than one type of treatment.
Late effects that affect the kidney may cause certain health problems.
Kidney late effects or related health problems include the following:
- Damage to the parts of the kidney that filter and clean the blood.
- Damage to the parts of the kidney that remove extra water from the blood.
- Loss of electrolytes, such as magnesium, calcium, or potassium, from the body.
- Hypertension (high blood pressure).
Possible signs and symptoms of kidney late effects include problems urinating and swelling of the feet or hands.
Sometimes there are no signs or symptoms in the early stages. Signs or symptoms may appear as damage to the kidney continues over time. Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to detect (find) and diagnose health problems in the kidney.
These and other tests and procedures may be used to detect or diagnose kidney late effects:
- Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood chemistry study : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as magnesium, calcium, and potassium, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance may be a sign of kidney disease.
- Urinalysis : A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the kidney, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of kidney late effects. If tests are needed, find out how often they should be done.
Health habits that promote healthy kidneys are important for survivors of childhood cancer.
Childhood cancer survivors who had all or part of their kidney removed should talk to their doctor about the following:
- Whether it is safe to play sports that have a high risk of heavy contact or impact such as football or hockey.
- Bicycle safety and avoiding handlebar injuries.
- Wearing a seatbelt around the hips, not the waist.
Bladder
Surgery to the pelvic area and certain types of chemotherapy increase the risk of bladder late effects.
The risk of health problems that affect the bladder increases after treatment with the following:
- Surgery to remove all or part of the bladder.
- Surgery to the pelvis, spine, or brain.
- Certain types of chemotherapy, such as cyclophosphamide or ifosfamide.
- Radiation therapy to areas near the bladder, pelvis, or urinary tract.
- Stem cell transplant.
Late effects that affect the bladder may cause certain health problems.
Bladder late effects and related health problems include the following:
- Hemorrhagic cystitis (inflammation of the inside of the bladder wall, which leads to bleeding).
- Thickening of the bladder wall.
- Trouble emptying the bladder.
- Incontinence.
- A blockage in the kidney, ureter, bladder, or urethra.
- Urinary tract infection (chronic).
Possible signs and symptoms of bladder late effects include changes in urination and swelling of the feet or hands.
These and other signs and symptoms may be caused by bladder late effects or by other conditions:
- Feeling the need to urinate without being able to do so.
- Frequent urination (especially at night).
- Trouble urinating.
- Feeling like the bladder does not empty completely after urination.
- Swelling of the legs, ankles, feet, face, or hands.
- Little or no bladder control.
- Blood in the urine.
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to detect (find) and diagnose health problems in the bladder.
These and other tests and procedures may be used to detect or diagnose bladder late effects:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood chemistry study: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as magnesium, calcium, and potassium, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance may be a sign of bladder problems.
- Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
- Urine culture : A test to check for bacteria, yeast, or other microorganisms in the urine when there are symptoms of infection. Urine cultures can help identify the type of microorganism that is causing an infection. Treatment of the infection depends on the type of microorganism that is causing the infection.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the bladder, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of bladder late effects. If tests are needed, find out how often they should be done.
To Learn More About Late Effects of Treatment for Childhood Cancer
For more information about late effects of treatment for childhood cancer, see the following:
For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:
About This PDQ Summary
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This PDQ cancer information summary has current information about the late effects of treatment for childhood cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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PDQ® Pediatric Treatment Editorial Board. PDQ Late Effects of Treatment for Childhood Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/childhood-cancers/late-effects-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389365]
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