A 55-year-old male with testicular cancer receiving cisplatin develops high-frequency sensorineural hearing loss and peripheral neuropathy. The nephroprotective strategy routinely employed during cisplatin administration is:

• A Aggressive IV hydration with saline and forced diuresis to maintain high urine flow ✓
• B Co-administration of N-acetylcysteine to chelate platinum ions
• C Co-administration of sodium thiosulfate to irreversibly bind cisplatin in the bloodstream
• D Amifostine infusion before each cisplatin dose to quench free radicals systemically

Explanation

Cisplatin accumulates in renal proximal tubule cells and collecting duct, causing direct tubular necrosis and electrolyte wasting (hypomagnesemia, hypokalemia, hypocalcemia). The standard nephroprotective strategy is aggressive pre- and post-hydration with 1–3 liters of normal saline with or without mannitol-induced forced diuresis to flush cisplatin through the tubules quickly, reducing contact time. Amifostine is occasionally used for nephroprotection but is not first-line. Sodium thiosulfate is used in intraperitoneal cisplatin protocols.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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