Abstract
Acute renal failure (ARF) in cancer patients is a dreadful complication that causes substantial morbidity and mortality. Moreover, ARF may preclude optimal cancer treatment by requiring a decrease in chemotherapy dosage or by contraindicating potentially curative treatment. The pathways leading to ARF in cancer patients are common to the development of ARF in other conditions. However, ARF may also develop due to etiologies arising from cancer treatment, such as nephrotoxic chemotherapy agents or the disease itself, including post-renal obstruction, compression or infiltration, and metabolic or immunological mechanisms. This article reviews specific renal disease in cancer patients, providing a comprehensive overview of the causes of ARF in this setting, such as treatment toxicity, acute renal failure in the setting of myeloma or bone marrow transplantation.
Highlights
Acute renal failure (ARF) is a serious complication of malignancies that causes substantial morbidity and mortality
The objective of this review is to describe specific aspects of renal disease in critically ill cancer patients (CICPs), to provide a comprehensive overview of the causes of ARF in this population, and to describe recent progress in the management of these complications, including treatment toxicity and bone marrow transplantation (BMT)
Prevention of ARF is mandatory in CICPs
Summary
Acute renal failure (ARF) is a serious complication of malignancies that causes substantial morbidity and mortality. We carefully checked the reviews and articles, ARF = acute renal failure; BMT = bone marrow transplantation; CICP = critically ill cancer patient; ICU = intensive care unit; SOS = Sinusoidal obstruction syndrome; TLS = tumour lysis syndrome; TMA = thrombotic microangiopathy. BMT recipients are exposed to multiple risk factors for acute renal dysfunction, including toxicity from medications (e.g., amphotericin and aminoglycoside) and contrast agents, sepsis, and extracellular dehydration These risk factors may increase the incidence or precipitate the development of ARF associated with a specific disease [44]. The prognosis of ARF remains ominous, with a reported mortality rate as high as 85% in patients requiring renal replacement therapy [41] This grim prognosis seems related in large part to the association between ARF and severe SOS [30,44]. Polymerase chain reaction testing or enzyme-linked immunosorbent assay may help to achieve this goal [51]
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