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Acute Renal Failure in Critically Ill Cancer Patients

  • Aisha Khattak
  • Kevin W. FinkelEmail author
Reference work entry

Abstract

Acute kidney injury remains a common complication in patients with cancer and is associated with increased length of stay, cost, and mortality. Furthermore, acute kidney injury can also lead to impaired functional status, decreased quality of life, and exclusion from further cancer therapy or trials. Patients with cancer are at risk for developing acute kidney injury from etiologies common to all hospitalized patients such as sepsis or exposure to nephrotoxic agents, including radiocontrast and antibiotics. In addition, acute kidney injury in these patients may be due to direct injury from the underlying malignancy (e.g., lymphomatous infiltration), chemotherapy toxicity (e.g., acute tubular necrosis), effects of hematopoietic stem cell transplantation, or from treatment complications (e.g., tumor lysis syndrome). Patient-related risk factors for acute kidney injury include older age, female gender, underlying chronic kidney disease, diabetes mellitus, volume depletion, and renal hypoperfusion. While cancer itself is not a contraindication for starting renal replacement therapy, the benefits of renal replacement therapy must be weighed against the overall prognosis of the patient and quality of life. A multidisciplinary discussion between the patient, nephrologist, oncologist, intensivist, and palliative care physicians is often necessary to make an informed clinical decision.

Keywords

Acute kidney injury Chemotherapy Tumor lysis Bone marrow transplantation Thrombotic microangiopathy Renal replacement therapy Multiple myeloma Cast nephropathy Renal cell cancer Targeted therapy Immunotherapy 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Renal Diseases and HypertensionUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Department of Medicine, Division of Renal Diseases and HypertensionUTHealth Science Center at Houston–McGovern Medical SchoolHoustonUSA

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