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The increasing prevalence of neoplasias is associated with new clinical challenges, one of which is acute kidney injury (AKI). In addition to possibly constituting a clinical emergency, kidney failure significantly interferes with the choice and continuation of antineoplastic therapy, with prognostic implications in cancer patients. Some types of n...
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Context 1
... other causes specific of cancer patients should be remembered, among them nephrotoxicity caused by chemotherapy, TLS, renal injury related to MM, and renal carcinoma (post-nephrectomy). Table 5 shows the classes of drugs most frequently involved with nephrotoxicity in daily practice. ...Similar publications
Objective:
In this study, we used the TCGA database and ICGC database to establish a prognostic model of iron death associated with renal cell carcinoma, which can provide predictive value for the identification of iron death-related genes and clinical treatment of renal clear cell carcinoma.
Methods:
The gene expression profiles and clinical da...
Citations
... cycle, the incidence and severity of cumulative nephrotoxicity increase [5,6]. AKI is also an important complication in patients with cancer, which is associated with high morbidity and mortality [7,8]. Moreover, the prognosis of chemotherapy-induced AKI is reportedly poor [9,10]. ...
Background:
Acute kidney injury (AKI) caused by cisplatin is common and has a higher incidence of multiple use, resulting in a poor short- and long-term prognosis for patients. There is currently no good pre-medication AKI risk assessment tool. The aim of this study is to establish an AKI risk assessment nomogram for patients with multiple cisplatin applications.
Methods:
This study was a retrospective analysis of patients who were treated with non-first-time cisplatin chemotherapy regimen in Changzhou second people's Hospital affiliated to Nanjing Medical University from January 2016 to January 2022. All data of the development group were used to screen the impact factors of AKI via univariate and multivariate analyses. A nomogram was developed based on these impact factors and verified with verification group. The area under the curve (AUC) of receiver-operating characteristic (ROC) curve, calibration curves, and decision curve analyses (DCAs) were used to evaluate the nomogram.
Results:
Among the 256 patients enrolled in 450 cycles of chemotherapy, 282 were in the development cohort (97 AKI), and 168 were in the validation cohort (61 AKI). Multivariate logistic regression revealed that age, hypertension, diabetes, sCysC, uKim1 and a single dose of cisplatin were independently associated with AKI. The results showed that our model yielded satisfied diagnostic performance with an AUC value of 0.887 and 0.906 using the development group and on verification group. The calibration plots and DCA showed the superior clinical applicability of the nomogram. These results were verified in the validation cohort.
Conclusion:
A nomogram combining functional (sCysC) and tubular (uKim1) injury biomarkers with conventional clinical factors might assess the risk of AKI after multiple cycles of cisplatin chemotherapy.
... Generally, patients with distant metastasis have a larger tumor burden and poorer performance status compared to those without distant metastasis. During treatment, patients with distant metastasis are more prone to have a low oral intake, therapy-induced nausea, vomiting, and diarrhea, all of which play a role in pre-renal renal dysfunction (12,13). These pre-renal factors, along with intrinsic factors (ICI therapy), predispose patients with distant metastasis to RAEs. ...
Background:
Along with the widespread use of immune checkpoint inhibitors (ICIs), there has been a surge in immune-related adverse events which can limit the efficacy of ICIs. However, to date, there is a paucity of reports on renal adverse events (RAEs) related to ICIs. Therefore, this study reports the incidence, risk factors, pathological features of RAEs in patients receiving ICI therapy and its association with overall survival.
Methods:
The medical records of patients who received at least 1 cycle of anti-programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) monoclonal antibody (mAb) between January 1st 2018 and July 31th 2021 were retrospectively reviewed. All available serum creatinine data were extracted and used to calculate the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and RAEs were defined as a 25% decrease in eGFR from baseline. Logistic regression was used to analyze the risk factors for RAEs. The Kaplan-Meier method was used to compare the survival among patients with and without RAEs.
Results:
A total of 328 patients receiving ICI therapy were enrolled and 42 developed RAEs. Patients with RAEs had a lower median baseline acute monocyte count (AMC), higher median baseline ratio of lymphocyte and monocyte (LMR), were more likely to have hypertension, coronary heart disease, and distant metastasis, and were more likely to be receiving more cycles of ICI therapy. Multivariate analysis revealed that RAEs were associated with distant metastasis and the number of cycles of ICI therapy. RAEs were not associated with baseline creatinine, eGFR, ICI type, nor the line of ICI therapy. Regardless of whether patients were receiving first-line ICI therapy or non-first line ICI therapy, patients with RAEs had lower survival rates compared to patients without RAEs. Of the patients with RAEs, 2 received renal biopsies and were pathologically confirmed with acute interstitial nephritis (AIN).
Conclusions:
RAEs were not a rare complication in patients receiving ICIs treatment. Distant metastasis and the number of cycles of ICI therapy were associated with RAEs. Patients who developed RAEs were associated with worse survival.
... Imaging usually provides a diagnosis. False-negative imaging in the evaluation of obstructive uropathy may be due to hypovolemia, partial obstruction, or renal entrapment secondary to RPF causing obstruction [24]. Further diagnostic evaluations may include cystoscopy and retrograde pyelogram. ...
Acute kidney injury (AKI) can be a significant clue to solving a puzzling patient presentation. Postrenal AKI should be suspected if imaging shows any degree of hydronephrosis and can be caused by a variety of conditions. Diagnosis of urinary obstruction without significant dilatation of the pelvic-ureteral system requires a higher degree of suspicion, and hence, its identification can become late. In patients without prior cancer screening, the etiology of obstructive uropathy must be broadened to include primary or metastatic malignancy. Clinicians should look beyond the AKI to properly evaluate the etiology of the patient’s presentation and symptoms. In this report, we present the case of a middle-aged female with no known past medical history who presented with AKI secondary to malignant retroperitoneal fibrosis as the first manifestation of metastatic breast cancer. Her AKI was associated with acute onset anuria and was found to have nondilated postrenal AKI with no significant abnormalities on renal imaging. Early onset anuria in the setting of AKI, which persists despite fluid resuscitation, can suggest complete urinary tract obstruction even with reassuring results of initial renal images, and in the patient with no history of cancer screening, malignancy should be suspected as a primary cause of obstructive uropathy.
... Embora a insuficiência renal preexistente possa influenciar o resultado, estimase que 9 a 32% dos pacientes com câncer precisam de hemodiálise, mostrando uma alta taxa de mortalidade (72 a 85%). [1][2][3][4][5][6][7][8][9][10][11] A predição das futuras condições de saúde desses pacientes é crucial, e os médicos tentam prever as alterações em suas condições clínicas o mais cedo possível, com a finalidade de ajustar os tratamentos, influenciar na eventual falência de órgãos em estágio inicial e evitar resultados desfavoráveis. A lesão renal aguda (LRA) é uma das mais comuns falências de órgão em pacientes críticos e afeta cerca de 40% das admissões à UTI. ...
... Assim, houve um aumento na sobrevida dos pacientes e o manejo das complicações da doença e os efeitos adversos do tratamento também se tornaram mais comuns. 8 Pacientes críticos necessitam de suporte específico para preservar as funções de seus órgãos vitais, razão pela qual são tratados em unidades de terapia intensiva (UTI). A predição das futuras condições de saúde desses pacientes é crucial, e os médicos tentam prever as alterações em suas condições clínicas o mais cedo possível, com a finalidade de ajustar os tratamentos, influenciar na eventual falência de órgãos em estágio inicial e evitar resultados desfavoráveis. ...
Objetivo: analisar a produção científica sobre a lesão renal aguda causada pela síndrome da Lise tumoral no paciente internado em unidade de terapia intensiva, bem como o conhecimento do enfermeiro sobre tal patologia. Método: Trata-se de um artigo de revisão integrativa realizado através da leitura de 30 artigos científicos retirados da Biblioteca Virtual de Saúde. Resultados: Identificou-se a ocorrência da lesão renal aguda e síndrome de lise tumoral através das alterações metabólicas e hemodinâmicas nos pacientes internados na unidade de terapia intensiva e observou-se que não há publicações com relatos do enfermeiro sobre o conhecimento desta patologia. Conclusão: Apesar dos estudos atuais e a busca constante pelo conhecimento, sabe-se que a lesão renal aguda e Síndrome de Lise Tumoral é uma emergência oncológica com alta taxa de morbidade, onde a principal estratégia para melhorar a evolução de pacientes é estabelecer medidas profiláticas e o tratamento adequado com urgência. Deve existir uma análise contínua do enfermeiro, bem como de toda equipe, estratificação dos riscos e elaboração de protocolos de controles hidroeletrolíticos e laboratoriais para estabilização hemodinâmica do paciente oncológico na unidade de terapia intensiva. Descritores: Lesão Renal Aguda; Unidade de Terapia Intensiva; Síndrome da Lise tumoral.
... Moreover, AKI can occur because of hydroelectrolytic complications associated with NHL, such as hyperuricemia, hyperphosphatemia, hypocalcemia, and hyperkalemia [14]. AKI worsens the prognosis of any associated comorbidity as it increases the mortality rate in patients with cancer [22], causes complications in ICU patients with sepsis [16] and increases the cytotoxic effects of chemotherapy [23]. One of the most common complications of chemotherapy is febrile neutropenia, which is often associated with anemia and thrombocytopenia [24]. ...
... Leukocytosis or neutrophilia (leukocytes >15,000/μl, neutrophil count >12,000/μl) was detected in 38% of cases with a BCR>20 and in 35% of cases with a BCR of 15-20. Leucopenia or neutropenia (leucocytes <2,000/μ/l, neutrophil count <1,000/μl) was found in 13% of cases with BCR>20 and in 15% of cases with a BCR of [15][16][17][18][19][20] weeks (range=<1-37 weeks) in cases with a BCR 15-20 (range=<1-27 weeks) and one week (range=<1-36 weeks) in cases with a BCR>20. Survival time was statistically different between the two groups (p<0.005, ...
... Cancer patients are at high risk for the development of AKI (14)(15)(16)(17)(18)(19), which is related to the production of inflammatory cytokines and results in an increased mortality rate (19). In this study, the cancer patients that had concurrent AKI died in a very short time, and the mean survival time was only one week. ...
... Production of inflammatory cytokines can be due to cancer itself or to responses of the patients to invasive procedures, therapies, or infections (11,20). Similarly, AKI in cancer patients can be secondary to cancer itself, driven by reactions of patients to bacterial infection, chemotherapy, or surgery (14)(15)(16). Half of our cases developed AKI due to other complications, such as septicemia or infection. As recurrent AKI is common in patients who have already been hospitalized with AKI, and because AKI is associated with an increased rate of death (21,22), there is a need for clinicians to quickly identify risk factors and generate appropriate management plans (18). ...
Background/aim:
A retrospective study of cases with metastatic or advanced solid tumors complicated with AKI (acute kidney injury) with prerenal azotemia.
Patients and methods:
Criteria included: (1) advanced or metastatic solid tumors that led to mortality; (2) prerenal azotemia identified upon renal function evaluation and (3) BUN to Cr ratio (BCR)≥15. We also compared the outcomes of patients with BCR>20 with those of patients with BCR=15-20.
Results:
A total of 218 patients with solid tumors were enrolled. One hundred and forty (64%) and 78 (36%) patients had BCR>20 and 15-20, respectively. Before AKI occurrence, 136 (62%) had thromboembolic complications and 96 (44%) paraneoplastic syndromes. Median survival time was 1 week in all patients. Median survival time was statistically different between the groups with BCR15-20 and BCR>20 (p<0.005, log-rank test).
Conclusion:
Cancer patients with concurrent AKI and prerenal azotemia carry a very poor prognosis.
Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.
In the coming years, accelerated progress against oncologic and hematologic diseases will be associated with a greater number of patients requiring life support therapies. In this chapter, we seek to highlight recent changes in the use and outcomes of intensive care in onco-hematologic patients. In recent decades, we have shown a substantial increase in our understanding of organ dysfunctions in the population of patients with solid and hematological malignancies, in the more appropriate use of life support therapies and in the selection of new and better therapeutic approaches that have been increasing survival of these patients. While reading this chapter, the reader is expected to reflect on the daily management of critically ill onco-hematological patients, from the management of toxicity to palliative care, and to understand the role and importance of the pharmacist within the field of oncology among critically ill patients.
In this chapter, we bring up a discussion on the differences between conventional chemotherapy and target therapy, highlighting the benefits as well as the disadvantages of target therapy, compared to systemic chemotherapy that has been used for years in the treatment of cancer. We discuss the main eligibility criteria for the administration of the targeted therapy and the main side effects of this therapy in cancer patients. We bring a discussion about the future of the targeted therapy, highlighting whether the targeted therapy aims to replace conventional chemotherapy, as well as the benefits with the combination of the benefits of both therapies in the treatment of cancer.
This chapter covers the main therapeutic modalities for the treatment of cancer, covering cancer surgery and radiation therapy, as well as the types and classifications of radiation therapy, finally addressing conventional chemotherapy. Here, we present the main classes of antineoplastic chemotherapeutic agents that include alkylating agents, antimetabolites, plant derivatives, and antineoplastic antibiotics, citing examples of drugs present in each group, as well as their therapeutic indications. Also, we bring here the main toxicities induced by conventional chemotherapy, such as nephrotoxicity, hepatotoxicity, neurotoxicity, cardiotoxicity, gastrointestinal toxicity, among others.
