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Overview of kidney disease in the cancer patient

Authors
Mitchell H Rosner, MD
Mark A Perazella, MD, FACP
Colm C Magee, MD, MPH, FRCPI
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Cancer is the second leading cause of death in the United States and is associated with significant morbidity [1]. As survival rates of patients with cancer have improved over the past few decades, an increasing number of cancer survivors have or will develop kidney disease associated with malignancy or its treatment. A variety of renal complications can occur among cancer patients, including acute kidney injury (AKI), chronic kidney disease (CKD), proteinuria and nephrotic syndrome, and electrolyte disorders.

This topic will provide an overview of the major kidney complications that affect patients with cancer. Kidney disease in patients with multiple myeloma or other monoclonal gammopathies, kidney disease among cancer patients who have undergone hematopoietic cell transplantation (HCT), and the nephrotoxicity of specific chemotherapeutic agents are discussed elsewhere. (See "Epidemiology, pathogenesis, and etiology of kidney disease in multiple myeloma and other monoclonal gammopathies" and "Clinical features, evaluation, and diagnosis of kidney disease in multiple myeloma and other monoclonal gammopathies" and "Treatment and prognosis of kidney disease in multiple myeloma and other monoclonal gammopathies" and "Kidney disease following hematopoietic cell transplantation" and "Chemotherapy-related nephrotoxicity and dose modification in patients with renal insufficiency".)

EPIDEMIOLOGY AND PROGNOSIS

AKI in cancer patients — Acute kidney injury (AKI) is a common complication in cancer patients that is associated with lower remission rates and increased mortality, hospital length of stay, and cost [2]. In a Danish population-based study that followed 37,267 incident cancer patients from 1999 to 2006, the one- and five-year risks of AKI, as defined by a >50 percent increase in serum creatinine compared with a baseline serum creatinine measured within one year of cancer diagnosis, were 17.5 and 27 percent, respectively [3]. The risk of AKI was highest in patients with kidney cancer (44 percent), liver cancer (33 percent), and multiple myeloma (32 percent). Renal replacement therapy (RRT) was required in 5.1 percent of patients within one year of AKI onset.

The risk of AKI may be higher in certain groups of cancer patients, such as those who are critically ill [4,5], those with hematologic malignancies (eg, patients with acute lymphoma or leukemia undergoing treatment) [6], those who have undergone hematopoietic cell transplantation (HCT), and those who have undergone nephrectomy for renal cell carcinoma (RCC) [7,8]. (See "Kidney disease following hematopoietic cell transplantation" and 'AKI after nephrectomy' below.)

Most observational studies have shown that cancer patients who develop AKI, particularly those who require RRT, have a higher risk of mortality than those who do not have AKI [4,6,9-11]. In one study of 288 cancer patients admitted to a cancer intensive care unit in Brazil, mortality among patients with RIFLE Risk, Injury, and Failure stages of AKI was 49, 62, and 87 percent, respectively, compared with 14 percent among those without AKI [4].

                                         

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Literature review current through: May 2017. | This topic last updated: May 04, 2017.
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