Acute Kidney Injury in Oncology Patients

Wang, Liyan; Wang, Jiani; Diao, Zongli; Guan, Yihan; Liu, Wenhu

doi:10.7150/jca.45382

Cited by 6 publications

(7 citation statements)

References 70 publications

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“…The main reason for submitting a cancer patient to kidney biopsy was acute kidney failure [ 25 , 26 , 27 ]: classically, between 12% and 27% of oncologic patients develop AKI [ 28 ]. More recently, an increase in the incidence of AKI in cancer patients has been observed, from 18 to 52 cases per 1000 people-years from 2007 to 2014 [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Kidney Biopsy in Patients with Cancer along the Last Decade: A Multicenter Study

Bolufer¹,

García-Carro

Blasco

et al. 2022

JCM

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Background: Currently, following the new advances in cancer treatments and the increasing prevalence of kidney disease in the population, more kidney biopsies are being performed. The aim of our study is to analyze clinical and histological characteristics of patients with active solid organ malignancy who underwent kidney biopsy. This is a multi-center collaborative retrospective study supported by groups GLOSEN/Onconephrology from the Spanish Society of Nephrology. Clinical, demographical and histological data were collected. Results: A total of 148 patients with cancer who underwent a kidney biopsy from 12 hospitals were included. 64.3% men and mean age of 66.9 years old. The indications for biopsy were acute renal injury (67.1%), proteinuria (17.1%), exacerbated chronic kidney disease (8.2%), and chronic kidney disease (7.5%). Most frequent malignances were lung (29.1%) and abdominal (25%), with 49.7% metastatic cancer. As oncospecific treatment, 28% received chemotherapy, 29.3% immunotherapy, 19.3% specific therapies, and 2.1% conservative treatment. At the time of kidney biopsy, median creatinine was of 2.58 mg/dL [1.81–4.1 (IQ 25–75)], median urine protein-to-creatinine ratio of 700 mg/g [256–2463 (IQ 25–75)] and 53.1% presented hematuria. The most frequent renal biopsy diagnoses were: acute interstitial nephritis (39.9%), acute tubular necrosis (8.8%), IgA nephropathy (7.4%) and membranous nephropathy (6.1%). Median follow-up was 15.2 months [5.7–31.4 (IQ 25–75)]. Conclusions: There is a new trend in kidney disease and cancer patients in terms of diagnosis and treatment. Acute interstitial nephritis has established itself as the most common kidney injury in patients with cancer who underwent a kidney biopsy. Renal biopsy is a valuable tool for diagnosis, treatment, and prognosis of solid organ cancer patients with kidney damage.

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Section: Discussionmentioning

confidence: 99%

Kidney Biopsy in Patients with Cancer along the Last Decade: A Multicenter Study

Bolufer¹,

García-Carro

Blasco

et al. 2022

JCM

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“…AKI may certainly have a complex pattern of specific causes in patients with solid cancer as well, predominantly mediated not only by toxic effects of systemic chemotherapy (15, 16, 32). These include direct tubular injury (such as by Platinum-containing regimens), tubulointerstitial disease, and crystalline nephropathy, but also induction of glomerular injury and glomerular disease (focal segmental sclerosis) and thrombotic microangiopathy (16).…”

Section: Discussionmentioning

confidence: 99%

Association of Acute Kidney Injury Receiving Kidney Replacement Therapy With Prognosis of Critically Ill Patients With and Without Cancer: A Retrospective Study

Druml

Zajic

Schellongowski

et al. 2021

Critical Care Medicine

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To assess outcomes of cancer patients receiving kidney replacement therapy due to acute kidney injury in ICUs and compare these with other patient groups receiving kidney replacement therapy in ICUs.DESIGN: Retrospective registry analysis. SETTING:Prospectively collected database of 296,424 ICU patients. PATIENTS:Patients with and without solid cancer with acute kidney injury necessitating kidney replacement therapy were identified and compared with those without acute kidney injury necessitating kidney replacement therapy. INTERVENTIONS:Descriptive statistics were used to ascertain prevalence of acute kidney injury necessitating kidney replacement therapy and solid cancer in ICU patients. Association of acute kidney injury necessitating kidney replacement therapy and cancer with prognosis was assessed using logistic regression analysis. To compare the attributable mortality of acute kidney injury necessitating kidney replacement therapy, 20,154 noncancer patients and 2,411 cancer patients without acute kidney injury necessitating kidney replacement therapy were matched with 12,827 noncancer patients and 1,079 cancer patients with acute kidney injury necessitating kidney replacement therapy. MEASUREMENTS AND MAIN RESULTS:Thirty-five thousand three hundred fifty-six ICU patients (11.9%) had solid cancer. Acute kidney injury necessitating kidney replacement therapy was present in 1,408 (4.0%) cancer patients and 13,637 (5.2%) noncancer patients. Crude ICU and hospital mortality was higher in the cancer group (646 [45.9%] vs 4,674 [34.3%], p < 0.001, and 787 [55.9%] vs 5,935 [43.5%], p < 0.001). In multivariable logistic regression analyses, odds ratio (95% CI) for hospital mortality was 1.73 (1.62-1.85) for cancer compared with no cancer 3.57 (3.32-3.83) for acute kidney injury necessitating kidney replacement therapy and 1.07 (0.86-1.33) for their interaction. In the matched subcohort, attributable hospital mortality of acute kidney injury necessitating kidney replacement therapy was 56.7% in noncancer patients and 48.0% in cancer patients. CONCLUSIONS:Occurrence rate of acute kidney injury necessitating kidney replacement therapy and prognosis in ICU patients with solid cancer are comparable with other ICU patient groups. In cancer, acute kidney injury necessitating kidney replacement therapy is associated with higher crude hospital mortality. However, the specific attributable mortality conveyed by acute kidney injury necessitating kidney replacement therapy is actually lower in cancer patients than in noncancer patients. Diagnosis of cancer per se does not justify withholding kidney replacement therapy.

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“…When AKI is caused by postrenal factors, the obstruction should be relieved first, and a J-tube should be placed in a timely manner to ensure smooth drainage. Timely imaging examinations and disease management in patients with gastrointestinal tumors are important because these patients constitute a high-risk group for postrenal AKI[ 117 ]. If AKI is not due to a postrenal factor, maintaining adequate hydration is the most important intervention for prerenal AKI and ATN and is easily administered.…”

Section: Preventive Measures and Treatments For Aki In Gastrointestinal Tumor Patientsmentioning

confidence: 99%

“…It is necessary to consider that treatment can lead to further kidney complications, including AKI, under certain circumstances. This change in kidney function can necessitate adjusting a patient’s cancer care, including chemotherapy options, diagnostic evaluation options, and other types of supportive care[ 117 ].…”

Section: Preventive Measures and Treatments For Aki In Gastrointestinal Tumor Patientsmentioning

confidence: 99%

Management of acute kidney injury in gastrointestinal tumor: An overview

Su¹,

Yu²,

Shen³

et al. 2021

WJCC

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Gastrointestinal tumors remain a global health problem. Acute kidney injury (AKI) is a common complication during the treatment of gastrointestinal tumors. AKI can cause a decrease in the remission rate and an increase in mortality. In this review, we analyzed the causes and risk factors for AKI in gastrointestinal tumor patients. The possible mechanisms of AKI were divided into three groups: pretreatment, intrafraction and post-treatment causes. Treatment and prevention measures were proposed according to various factors to provide guidance to clinicians and oncologists that can reduce the incidence of AKI and improve the quality of life and survival rate of gastrointestinal tumor patients.

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Acute Kidney Injury in Oncology Patients

Cited by 6 publications

References 70 publications

Kidney Biopsy in Patients with Cancer along the Last Decade: A Multicenter Study

Kidney Biopsy in Patients with Cancer along the Last Decade: A Multicenter Study

Association of Acute Kidney Injury Receiving Kidney Replacement Therapy With Prognosis of Critically Ill Patients With and Without Cancer: A Retrospective Study

Management of acute kidney injury in gastrointestinal tumor: An overview

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