Acute Renal Failure After Cancer Treatment

Acute Renal Failure After Cancer Treatment Posted By:
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Acute renal failure (ARF) in cancer patients is a dreadful complication that causes substantial morbidity and mortality. ARF is defined as a sustained and abrupt decline, within hours to days, of the glomerular filtration rate (GFR). Nearly one in 10 cancer patients treated with chemotherapy or newer targeted drugs may be hospitalized for serious kidney injury. Among critically ill cancer patients (CICPs), 12% to 49% experience ARF and 9% to 32% require renal replacement therapy during their ICU stay. The risk for ARF seems higher in CICPs than in other critically ill patients. In critically ill patients with cancer, acute renal dysfunction usually occurs in the context of multiple organ dysfunctions and is associated with mortality rates ranging from 72% to 85% when renal replacement therapy is needed.

Malignancies with the highest incidence of acute kidney injury (AKI) are multiple myeloma, bladder cancer, leukemia, and kidney cancer. Advanced cancer stage, chronic kidney disease, and diabetes were all associated with an increased risk of AKI, and AKI risk was accentuated during the 90-day period following systemic therapy. The definition for AKI used in clinical and epidemiologic studies is based on specific criteria that have been sequentially developed. The Kidney Disease Improving Global Outcomes (KDIGO) definition and staging system is the most recent and preferred definition. Using the KDIGO criteria, AKI is staged as follows:

  • Stage 1: Increase in serum creatinine to 1.5-1.9 times baseline or increase in serum creatinine by ≥0.3 mg/dL (≥26.5 micromol/L), or reduction in urine output to <0.5 mL/kg/hour for 6 to 12 hours
  • Stage 2: Increase in serum creatinine to 2.0-2.9 times baseline, or reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
  • Stage 3: Increase in serum creatinine to 3.0 times baseline, or increase in serum creatinine to ≥4.0 mg/dL (≥353.6 micromol/L), or reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or anuria for ≥12 hours, or the initiation of renal replacement therapy, or, in patients <18 years, decrease in estimated GFR (eGFR) to <35 mL/min/1.73 m2

While the general approach to ARF in cancer patients is not different from that used for other patients, nephrology consultation is important to ensure proper and rapid diagnosis, as well as appropriate therapy and follow-up. Nephrologists suggest that appropriate renal monitoring could allow for early intervention in reducing the consequences of renal toxicity on further treatment. Optimal monitoring includes a baseline evaluation to detect/identify patients with preexisting nephropathy and patients at high risk of renal impairment.

Knowledge of the nephrotoxicity of the various anticancer regimens employed is also critical if you provide care to this population frequently. This is a rapidly evolving area that requires continuous updating as new drugs are released into clinical practice and nephrotoxicity is observed.

References
  • Campbell GA, Hu D, Okusa MD. Acute kidney injury in the cancer patient. Adv Chronic Kidney Dis. 2014;21:64-71.
  • Christiansen CF, Johansen MB, Langeberg WJ, Fryzek JP, Sørensen HT. Incidence of acute kidney injury in cancer patients: a Danish population-based cohort study. Eur J Intern Med. 2011;22:399-406.
  • Darmon M, Ciroldi M, Thiery G, Schlemmer B, Azoulay E. Clinical review: specific aspects of acute renal failure in cancer patients. Crit Care. 2006;10:211.
  • International Society of Nephrology. KDIGO Clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:8.
  • Rosner MH, Perazella MA. Acute kidney injury in patients with cancer. N Engl J Med. 2017;376:1770-1781.

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Filed under: Urology , Oncology/Hematology

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