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Review
. 2021 Mar 29;11(4):611.
doi: 10.3390/diagnostics11040611.

Acute Kidney Injury in the Patient with Cancer

Alejandro Meraz-Munoz  1 , Amit Langote  2 , Kenar D Jhaveri  3 , Hassane Izzedine  4 , Prakash Gudsoorkar  5
Affiliations
Review

Acute Kidney Injury in the Patient with Cancer

Alejandro Meraz-Munoz et al. Diagnostics (Basel). .

Abstract

Over the last three decades, advancements in the diagnosis, treatment, and supportive care of patients with cancer have significantly improved their overall survival. However, these advancements have also led to a higher rate of cancer-related complications. Acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent in patients with cancer, and they are associated with an increased risk of all-cause mortality. This bidirectional interplay between cancer and kidney, termed "the kidney-cancer connection" has become a very active area of research. This review aims to provide an overview of some of the most common causes of AKI in patients with cancer. Cancer therapy-associated AKI is beyond the scope of this review and will be discussed separately.

Keywords: acute kidney injury (AKI); hematopoietic stem cell transplant (HSCT); kidney replacement therapy (KRT); thrombotic microangiopathy (TMA); tumor lysis syndrome (TLS).

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Conflict of interest statement

K.D.J. servers as a consultant for Astex pharmaceuticals and Natera.

Figures

Figure 1
Figure 1
Acute kidney injury in cancer.AKI: acute kidney injury, Ca+: calcium, HSCT: hematopoietic stem cell transplant, TLS: tumor lysis syndrome, TMA: thrombotic microangiopathy.
Figure 2
Figure 2
Mechanisms causing TMA in patients with cancer. ADAMTS-13 = a disintegrin and metalloproteinase with thrombospondin type-1 motif, member 13, PDGF = platelet derived growth factor. VEGF = vascular endothelial growth factor, RBC = red blood cell, RES = reticuloendothelial system.
Figure 3
Figure 3
Pathogenesis of HSCT-associated AKI. HSCT = hematopoietic stem cell transplant, GVHD = graft vs. host disease, Glom = glomerular, MCD = minimal change disease, IgAN = IgA nephropathy, MPGN = membranoproliferative glomerulonephritis, FSGS = focal segmental glomerulosclerosis, PTCitis = peritubular capillaritis, CNI = calcineurin inhibitor, MTx = methotrexate, TLS = tumor lysis syndrome, HTN = Hypertension.
Figure 4
Figure 4
Infographic that summarizes prevention and treatment of tumor lysis syndrome. TLS = tumor lysis syndrome, UO = urine output, CalPhos = calcium phosphate, UA = uric acid, XO = xanthine oxidase, Rx = treatment, C/I = contraindication, G6PD = glucose 6 phosphate dehydrogenase, AKI = acute kidney injury, HD = hemodialysis, CVVH/HD = continuous veno venous hemofiltration/hemodialysis.
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