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Review
. 2021 Dec 24;15(5):873-884.
doi: 10.1093/ckj/sfab292. eCollection 2022 May.

Treatment of acute kidney injury in cancer patients

Pauline Braet  1 , Giulia Vanessa Re Sartò  2 , Marta Pirovano  2 , Ben Sprangers  1 , Laura Cosmai  2
Affiliations
Review

Treatment of acute kidney injury in cancer patients

Pauline Braet et al. Clin Kidney J. .

Abstract

Acute kidney injury (AKI), either of pre-renal, renal or post-renal origin, is an important complication in cancer patients, resulting in worse prognosis, withdrawal from effective oncological treatments, longer hospitalizations and increased costs. The aim of this article is to provide a literature review of general and cause-specific treatment strategies for AKI, providing a helpful guide for clinical practice. We propose to classify AKI as patient-related, cancer-related and treatment-related in order to optimize therapeutic interventions. In the setting of patient-related causes, proper assessment of hydration status and avoidance of concomitant nephrotoxic medications is key. Cancer-related causes mainly encompass urinary compression/obstruction, direct tumoural kidney involvement and cancer-induced hypercalcaemia. Rapid recognition and specific treatment can potentially restore renal function. Finally, a pre-treatment comprehensive evaluation of risks and benefits of each treatment should always be performed to identify patients at high risk of treatment-related renal damage and allow the implementation of preventive measures without losing the potentialities of the oncological treatment. Considering the complexity of this field, a multidisciplinary approach is necessary with the goal of reducing the incidence of AKI in cancer patients and improving patient outcomes. The overriding research goal in this area is to gather higher quality data from international collaborative studies.

Keywords: CAR T-cells; acute kidney injury; cancer; checkpoint inhibitors; chemotherapy; multiple myeloma; renal replacement therapy.

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Figures

FIGURE 1:
FIGURE 1:
ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ATIN, acute tubulointerstitial nephritis.
FIGURE 2:
FIGURE 2:
IF, immunofixation; SPEP, serum protein electrophoresis.
FIGURE 3:
FIGURE 3:
CI-AKI, contrast-induced acute kidney injury; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration.
FIGURE 4:
FIGURE 4:
ULN, upper limit of normal.
See this image and copyright information in PMC

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