Bendamustine
Treanda · Alkylator
Tumor lysis-mediated AKI is the principal risk; TMA is rare.
PRETMALYTE
ModerateOpen →
Cytokine
Interleukin-2 (high-dose)
Proleukin · IL-2
Capillary leak drains the circulation — the kidney starves, then recovers.
ModerateCytokine immunotherapy · approved 1992
Metastatic melanomaRenal cell
Signature kidney injury
Prerenal / Hemodynamic AKI
Oliguria / prerenal AKI is very common during therapy — almost universal at high dose — but reversible.
Source: Belldegrun et al., Ann Intern Med 1987
Mechanism of kidney injury
Vascular (capillary) leak syndrome depletes the intravascular volume and drops blood pressure, starving renal perfusion (prerenal); secondary cytokines add an intrinsic component with a reduced filtration fraction.
Clinical presentation
Oliguria, hypotension, weight gain and edema with a rising BUN/creatinine and a very low fractional excretion of sodium during treatment.
Onset
Acute — during the treatment cycle.
Reversibility
Reversible
Anticancer mechanism
Recombinant aldesleukin stimulates T-cell and NK proliferation for anti-tumor immunity. Metastatic melanoma and renal cell carcinoma.
Management
Dose-hold, hemodynamic support (judicious fluids/pressors), supportive care.
Risk factors
- Pre-existing CKD
- Hypotension
- Concurrent nephrotoxins
Prevention
- Careful fluid / hemodynamic management
- ICU-level monitoring
Note · Reversibility is the key teaching point — typically resolves within a dose-hold.
Where it strikes
Nephron segments
Vasculature / Endothelium
Glomerular & peritubular capillaries
Injury signatures
Prerenal / Hemodynamic AKI
Beyond the kidney
Class-level context for the major non-renal toxicities of cytokines.
Immune / Infusion
CRS, infusion reactions, irAEs, anaphylaxis
- Flu-like syndrome, capillary leak (IL-2)
Neurologic
Neuropathy, encephalopathy, ICANS, PRES
- Depression, fatigue (interferon)
Evidence
4 peer-reviewed references. Citation metadata via PubMed / NLM.
LandmarkEffects of interleukin-2 on renal function in patients receiving immunotherapy for advanced cancer.Belldegrun A et al. · Ann Intern Med 1987 · PMID 3495213Landmark: reversible prerenal azotemia with predictable recovery.PMIDMetabolic and renal effects of interleukin-2 immunotherapy for metastatic cancer.Webb DE et al. · Clin Nephrol 1988 · PMID 3263237Documents the reversible renal hypoperfusion syndrome (very low FeNa).PMIDEffects of interleukin-2 immunotherapy on renal function.Kozeny GA et al. · J Clin Oncol 1988 · PMID 3260620Capillary leak causing prerenal azotemia without tubular dysfunction.PMIDAcute renal dysfunction during interleukin-2 treatment: suggestion of an intrinsic renal lesion.Shalmi CL et al. · J Clin Oncol 1990 · PMID 2230870Shows an intrarenal component beyond pure prerenal azotemia.
Related agents
Other agents sharing the same signature kidney injury.