Indirect: hypoadrenalism drives hyponatremia/prerenal; cisplatin nephrotoxicity in EDP-M.

Creatinine rise via reduced tubular secretion.

Creatinine elevation; usually benign.

GI-driven prerenal AKI.

Edema and metabolic effects.

Reversible creatinine rise and renal cysts.

Mild reversible creatinine rises only; dose-limiting toxicities are neurologic and GI; renal data confounded by cisplatin.

Minimal direct nephrotoxicity; rare drug-associated SIADH/hyponatremia is the kidney-relevant signal.

Tumor lysis in bulky lymphoma is the main renal hazard; modern topical gel has no detectable systemic absorption.

Tumor lysis-mediated AKI is the principal risk; TMA is rare.

Conditioning-regimen TMA risk.

Rare hepatic veno-occlusive disease; minimal direct renal injury.

SIADH in high-dose myeloma conditioning; renally cleared.

Occasional SIADH; generally renally well tolerated.

Hemorrhagic cystitis; renally cleared.

Hypertension; rare electrolyte effects.

Tumor lysis; low direct renal toxicity.

Experimental podocyte model; clinical proteinuria rare.

Tumor lysis in acute leukemia.

High tumor-lysis risk in CLL.

Tumor lysis with bulky disease; treats some GN.

Tumor lysis; usable in renal impairment.

Tumor lysis in myeloma.

TRPM6 magnesium wasting.

Severe hypomagnesemia, class effect.

Capillary-leak syndrome, hypertension and severe pain in neuroblastoma.

ICI-associated AIN.

ICI-associated AIN.

Interstitial nephritis; rare glomerular disease.

ICI-associated AIN.

ICI-associated AIN.

Severe hypocalcemia in low GFR; not directly nephrotoxic.

Kidney-neutral antibody; unchanged PK in severe impairment and dialysis; no renal dose adjustment.

Proteinuria, hypertension, glomerular TMA.

Hypertension and proteinuria, class effect.

Myeloma ADC; renal data emerging.

Tumor lysis and VOD in ALL.

Tumor lysis in lymphoma.

Tumor lysis and veno-occlusive disease.

Tumor lysis; emerging renal data.

Ocular toxicity dominates; renal involvement indirect/case-level (GI volume loss).

Rare nodular regenerative TMA-like signals.

Emerging AKI/proteinuria reports — under-published.

Emerging AKI and electrolyte signals in urothelial cancer.

Diarrhea-driven prerenal AKI; emerging direct signals.

Crystal nephropathy; glucarpidase rescue.

Cumulative tubular toxicity, RTA and nephrogenic DI.

Antifolate with MTX-like renal handling.

Renally cleared antifolate; exposure ~doubles in renal impairment; forerunner CB3717 withdrawn for crystal nephrotoxicity.

Lipophilic oral 5-FU prodrug (Japan); class-level renal risk; hallmark toxicity is leukoencephalopathy not nephropathy.

5'-DFUR prodrug; class-level TMA risk plus a real renal-clearance component warranting caution in renal impairment.

Oral tegafur+uracil; rare fluoropyrimidine-class TMA/HUS (often with mitomycin C), otherwise kidney-sparing.

Renally excreted (~2/3 in urine); half-life rises exponentially below CrCl 25-35 — exposure/clearance issue amplifying pulmonary toxicity, not a direct nephrotoxin.

Renal risk indirect via tumor lysis in chemosensitive pediatric tumors; hepatic veno-occlusive disease is the signature organ toxicity.

Prototype dose-dependent TMA.

Cumulative tubular ATN; hypocalcemia is an on-target antiresorptive effect.

Major tumor lysis syndrome risk on ramp-up.

Reversible eGFR decline.

Nephrotic-range proteinuria — a notable signal.

Fluid retention; rare Fanconi and AKI.

eGFR decline over time.

Vascular toxicity and hypertension.

CRS and tumor lysis — emerging.

CRS-associated AKI in myeloma — emerging signal.

CRS and tumor lysis — emerging.

CRS and tumor lysis — emerging.

CRS and tumor lysis in lymphoma.

CRS-related AKI — emerging.

Lower renal risk than zoledronate.

Collapsing FSGS — first drug ever linked.

Toxic ATN, infusion-rate dependent.

CRS and tumor lysis → AKI.

Renally excreted, so caution in renal impairment; myelosuppression is the dominant toxicity.

Renally excreted; dominant toxicity is reversible myelosuppression; caution in renal impairment.

Class tubular signal; usually mild.

Tubulointerstitial AKI; vemurafenib strongest.

Tumor lysis; lower hypertension than ibrutinib.

Tumor lysis, hypertension and AKI.

Tumor lysis in CLL/lymphoma.

CRS-driven prerenal AKI and tumor lysis.

Benign creatinine rise via tubular secretion block.

Generally renally well tolerated.

Creatinine rise; QT prolongation.

Mineralocorticoid excess: hypokalemia, hypertension, edema.

Collapsing FSGS in APOL1 carriers.

Capillary-leak prerenal AKI.

Differentiation syndrome; QT prolongation.

Diarrhea-driven prerenal AKI.

Rare minimal-change disease and AKI.

Rare nephrotic syndrome.

Hyponatremia and occasional AKI.

Rare AKI; pancreatitis-mediated.

Rare AKI; pancreatitis- and thrombosis-mediated.

Hyperphosphatemia is an on-target class effect.

Hyperphosphatemia, class effect.

Hyperphosphatemia; nephrocalcinosis risk.

Metabolic syndrome; indirect renal risk.

Muscle spasms; hyponatremia reported.

Anemia/hypoxia; emerging renal profile in VHL/RCC.

Fluid retention, edema and thromboembolism.

Classic cytotoxic with recognized renal/urological complications; AKI usually multifactorial; hypersensitivity AIN possible.

Renal tubular acidosis and rare AKI.

Tumor lysis in MDS/AML.

Differentiation syndrome → AKI; tumor lysis.

Differentiation syndrome and tumor lysis.

Capillary-leak syndrome → AKI.

Acute interstitial nephritis with long latency.

Renally cleared; AKI and rare Fanconi/TMA.

Tumor lysis; usable in renal impairment.

Tumor lysis and bradycardia.

Creatinine rise; emerging data.

Newer agent; renal data emerging.

Creatinine rise; rhabdomyolysis reports.

Real-world AKI signal with BRAF partners.

Creatinine rise in neurofibromatosis.

Reversible creatinine rise and edema.

Creatinine rise and peripheral edema.

Reduced clearance in renal impairment.

Podocyte injury → proteinuria and FSGS.

Proteinuria, cast nephropathy, delayed graft recovery.

Class delayed cumulative tubulointerstitial/ATN; usually mild; acute signal often really cisplatin.

Water-soluble nitrosourea; renal risk inferred at class level; cumulative delayed tubulointerstitial injury; DLT is myelosuppression.

Delayed interstitial fibrosis with high cumulative dose.

Cumulative interstitial nephritis and CKD.

Classic proximal tubular toxin → Fanconi and dose-limiting AKI.

Hepatically cleared, kidney-neutral, no renal dose adjustment; only rare idiosyncratic interstitial nephritis.

Tumor lysis in leukemia; high-dose toxicity.

Dose-cumulative thrombotic microangiopathy.

Tipiracil is renally cleared; reduced GFR raises exposure and early severe neutropenia; dose-reduce in renal impairment.

Vasopressin-independent hyponatremia; hemorrhagic cystitis.

Chloroacetaldehyde → Fanconi syndrome.

Hypertension and creatinine rise.

Benign creatinine rise via OCT2/MATE inhibition.

Transporter-mediated creatinine rise.

Renally cleared; creatinine rise.

Immune-mediated colitis → volume-depletion prerenal AKI; transaminitis.

Kidney-sparing; GFR-dosed by the Calvert formula.

Proximal tubular ATN + magnesium wasting; the archetype.

Second-gen platinum with reduced renal toxicity vs cisplatin.

Least nephrotoxic platinum; rare immune hemolysis.

Highly protein-bound, low renal clearance (~10-25% urinary); renal relevance is PK/exposure not direct injury; not dialyzable.

Rare TMA; reverses myeloma cast nephropathy.

AKI, TMA and hypertension — a hot myeloma signal.

Rare TMA reports.

Tumor lysis; high-dose nephrotoxicity.

Capillary-leak / SIRS-like AKI and tumor lysis.

Tumor lysis; accumulates in renal impairment.

Tumor lysis in T-ALL.

Renally cleared; dose-related acute kidney injury.

Rare TMA, esp. with mitomycin; mostly renally safe.

Diarrhea-driven prerenal AKI; dose-adjust for CrCl.

Yttrium-90 radioimmunotherapy; tumor lysis with bulky lymphoma.

Bone-seeking alpha emitter; minimal direct renal toxicity.

Hypertension; rare AKI.

Hypertension and creatinine rise.

Differentiation syndrome → capillary leak and AKI.

Tumor lysis in myeloproliferative disease.

Hypercalcemia flare; rare hyponatremia.

Kidney-neutral (CLARINET: diarrhea dominant); increased exposure in renal impairment.

Kidney-neutral/possibly renoprotective; renally cleared, caution in severe CKD/dialysis.

Rare AKI; mostly GI-mediated.

Fluid retention; low direct renal toxicity.

Low direct nephrotoxicity; vehicle reactions.

Diarrhea-driven prerenal AKI.

Renally cleared; dose-adjust for CrCl.

Tumor lysis; renally cleared.

Predominantly hepatobiliary elimination; renal clearance minor, kidney risk mainly tumor lysis in AML; reduce dose in organ impairment.

Intraperitoneal; cytokine-release- and ascites/paracentesis-driven prerenal AKI; withdrawn (EU) 2017.

Hypertension and proteinuria like bevacizumab.

Highest-ranked TKI for hypertension; proteinuria.

Hypertension and proteinuria.

Hypertension and proteinuria in RCC.

Hypertension as an on-target marker; proteinuria.

Hypertension; QT prolongation.

Proteinuria and rare TMA.

Hypertension and proteinuria; nephrotic case reports.

SIADH and rare Raynaud/vascular events.

SIADH → hyponatremia.

Used because of renal impairment (cisplatin-unfit urothelial); CrCl-based dose bands; watch SIADH/hyponatremia.

SIADH reports.

2023 breast-cancer AKT inhibitor; AKI with diarrhea/hyperglycemia.

Not nephrotoxic; exposure rises in severe renal impairment, so consider dose adaptation.

Tumor lysis and rare AKI; cutaneous T-cell lymphoma.

Tumor lysis and infusion reactions in lymphoma.

Capillary-leak-type edema, effusions and AKI.

Ocular/bleeding toxicity dominates; renal involvement essentially unreported.

Hypertension and pancreatitis; allosteric BCR-ABL inhibitor.

Boxed hepatotoxicity; secondary renal effects.

Diarrhea-driven prerenal AKI; QT prolongation.

Tumor lysis; generally low direct renal toxicity.

Hyperphosphatemia — on-target FGFR class effect; nephrocalcinosis risk.

Tumor lysis, edema and QT in AML/mastocytosis.

Differentiation syndrome, tumor lysis and PRES in AML.

2023 AML FLT3 inhibitor; tumor lysis and QT.

2023 desmoid-tumor agent; phosphate/electrolyte disturbance.

QT prolongation and muscle spasms; AML.

Elevated CK / rhabdomyolysis → pigment nephropathy.

Severe diarrhea → prerenal AKI; loperamide prophylaxis.

Benign creatinine rise via tubular secretion inhibition.

Boxed warning for capillary-leak syndrome and hemolytic-uremic syndrome / TMA.

2023 myelofibrosis JAK inhibitor.

Tumor lysis in myelofibrosis; renally adjusted.

Edema, intracranial bleeding and cognitive effects.

Hypertension and alopecia in GIST.

Rhabdomyolysis risk in small-cell lung cancer.

Rhabdomyolysis → pigment nephropathy; hepatotoxicity.

2023 BTK inhibitor; tumor lysis risk.

2023 oral SERD; nausea-dominant, minimal intrinsic nephrotoxicity.

Transient infusion-related hypertension and hyperglycemia.

Delivers melphalan intracellularly; BRIDGE supports a reduced 30 mg dose in moderate renal impairment.

Severe hyperglycemia (on-target) → osmotic diuresis and prerenal AKI risk.

Colitis and diarrhea → prerenal AKI.

Peptide receptor radionuclide therapy; proximal tubular radiation nephropathy is dose-limiting — amino-acid co-infusion is renoprotective.

2023 ROS1 inhibitor; creatinine rise via secretion block.

Mild creatinine rise; generally well tolerated.

Creatinine rise via reduced tubular secretion.

2023 colorectal VEGFR-TKI; hypertension and proteinuria, class effect.

Hyponatremia is common and dose-limiting.

2024 gastric mAb; severe on-target nausea/vomiting → volume-depletion prerenal AKI.

2025 TROP2 ADC; renal signal theoretical, extrapolated from the ADC class.

CRS-driven AKI; delayed neurotoxicity.

CRS-driven AKI and tumor lysis in myeloma.

2024 small-cell lung BiTE; CRS-driven AKI risk.

CRS-driven hypotension → prerenal AKI early in dosing; uveal melanoma.

2025 EGFR exon20 TKI; electrolyte effects emerging.

2024 EGFR TKI; hyponatremia like osimertinib.

Newly recognized acute interstitial nephritis in lung cancer — flagged by clinicians.

2024 biliary-tract HER2 bispecific; renal data emerging.

HER2 exon20 TKI (2025); creatinine rise likely a secretion artifact.

Differentiation syndrome and tumor lysis in AML.

2022 LAG-3 inhibitor (with nivolumab); class immune-mediated AIN, amplified by combination ICI.

Capillary-leak syndrome → prerenal AKI.

2025 NF1 MEK inhibitor; creatinine rise and edema.

2024 leukemia agent; differentiation syndrome and tumor lysis.

PSMA-targeted radioligand for prostate cancer; renal radiation exposure and xerostomia.

2024 MDS agent; tumor lysis risk.

2024 cellular therapy; high-dose IL-2 conditioning → capillary leak AKI.

2024 pediatric glioma RAF inhibitor; creatinine rise.

Trial-stage RCC HIF-2α inhibitor; renal profile being defined.

Trial-stage AML menin inhibitor; differentiation syndrome / TLS predicted.