Late Effects	Causative Treatment	Signs and Symptoms	Screening and Diagnostic Tests	Management and Intervention
aAdapted from Schwartz et al.[37]
Glomerular dysfunction	Chemotherapy: Cisplatin, carboplatin	Asymptomatic or fatigue, poor linear growth, anemia, oliguria	Annual: blood pressure, height, weight, hemoglobin/ hematocrit, urinalysis, creatinine, BUN; creatinine clearance baseline and every 3 years	Low-protein diet, dialysis, renal transplant
Hypoplastic kidney/renal arteriosclerosis	Radiation: 20–30 Gy; 10–15 Gy with chemotherapy	Fatigue, poor linear growth, hypertension, headache, edema (ankle, pulmonary), albuminuria, urinary casts, hepatomegaly	Annual: blood pressure, height, weight, hemoglobin/ hematocrit, urinalysis, creatinine, BUN;creatinine clearance baseline and every 3 years	Low-protein diet, dialysis, renal transplant
Tubular dysfunction	Chemotherapy: Cisplatin, carboplatin, ifosfamide	Seizures (↓magnesium [Mg]), weakness (↓phosphate [PO4]), glycosuria, poor linear growth	Annual: blood pressure, height, weight, hemoglobin/ hematocrit, urinalysis, creatinine, BUN; creatinine clearance baseline and every 3 years and Mg, PO4 (24-hour urine for calcium, PO4)	Mg supplement, PO4 supplement
Nephrotic syndrome	Radiation: 20–30 Gy	Proteinuria, edema	Urinalysis every year, blood pressure every year, (serum protein, albumin, creatinine [Cr], BUN) (24-hour urine for protein, Cr)	Low-salt diet, diuretics
Bladder: fibrosis or hypoplasia (reduced bladder capacity)	Chemotherapy: Cyclophosphamide, ifosfamide	Urgency, frequency, dysuria, incontinence (nocturia), pelvic hypoplasia	Urinalysis every year (cystoscopy, intravenous pyelogram/ultrasound: volumetrics)	Exercises to increase bladder capacity, surgical referral
	Radiation: >30 Gy prepubertal, >50 Gy postpubertal
Hemorrhagic cystitis	Chemotherapy: Cyclophosphamide, ifosfamide	Hematuria, frequency, urgency, dysuria, bladder tenderness	Urinalysis every year to rule out urinary tract infection (UTI), renal calculi (cystoscopy if hematuria on 2 exams)	Transfusion, antispasmodics, formalin, counsel regarding risk of bladder cancer
	Radiation: Radiation enhances chemotherapy effect

References

37. Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.