Abstract
Kidney disease is very common in patients with cancer. Nephrologists are vital members of the multidisciplinary care team for these patients. Given the high prevalence of comorbidities in patients treated for active malignancy, it is not surprising that these individuals frequently develop renal diseases that are common among other hospitalized patients, such as those arising from sepsis, hypotension or use of nephrotoxic agents (e.g. radiocontrast or antimicrobial agents). The role of the nephrologist in these cases differs little with respect to the presence or absence of cancer. On the other hand, there are several renal syndromes that are unique to patients with cancer, being caused either by the cancer itself or by its treatment. These syndromes are reviewed here. In addition, patients who are receiving chemotherapy often require dialysis for either acute or chronic kidney disease. Unfortunately, there is very little information on the clearance characteristics of most chemotherapeutic agents. In cancer patients with renal disease, both the timing of administration and the dose-adjustment of chemotherapy must rely on clinical experience and close clinical observation.
Key Points
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Patients with cancer are at high risk of developing acute kidney injury (AKI), caused either by the malignancy per se or by its treatment
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AKI in patients with cancer is associated with a higher mortality rate than is AKI in people without cancer
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The effect of dialysis on clearance of most chemotherapeutic agents (particularly those undergoing phase I or II trials) in many clinical circumstances is unknown
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Several renal syndromes are unique to patients with cancer and these include bone marrow transplant nephropathy, sinusoidal obstruction syndrome of the liver, radiation nephritis, tumor lysis syndrome, myeloma kidney, and toxic injury resulting from chemotherapy
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Finkel, K., Foringer, J. Renal disease in patients with cancer. Nat Rev Nephrol 3, 669–678 (2007). https://doi.org/10.1038/ncpneph0622
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DOI: https://doi.org/10.1038/ncpneph0622
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