The impact of hydronephrosis on renal function in patients treated with cisplatin-based chemotherapy for metastatic nonseminomatous germ cell tumors.

We analysed renal function before and after chemotherapy in 130 patients with large (greater than 5 cm in diameter) abdominal masses from malignant non-seminomatous germ cell tumors (NSGCT). The mean glomerular filtration rate assessed by 51Chromium (51Cr) ethylenediamine tetraacetic acid (EDTA) clearance was lower in 46 patients with radiologic evidence of hydronephrosis than in 84 patients with abdominal masses but no hydronephrosis (102 ml/min versus 139 ml/min; P less than 0.01). Patients with hydronephrosis who were treated with cisplatin-based chemotherapy demonstrated a slight early improvement in renal function followed by a fall, in contrast to those treated with carboplatin-based chemotherapy in whom renal function improved. Patients with hydronephrosis who showed no improvement in glomerular filtration rate after the first course of chemotherapy were at an increased risk of renal atrophy and chronic renal damage developing. Long-term renal toxicity may be avoided in these patients either by the use of carboplatin or by the use of drainage procedures such as ureteric stenting or nephrostomy.