Overview of renal disease associated with malignancy
- Colm C Magee, MD, MPH, FRCPI
Colm C Magee, MD, MPH, FRCPI
- Clinical Lecturer in Medicine
- Royal College of Surgeons
Malignancy or its treatment can produce a variety of renal diseases . Acute and chronic kidney disease and electrolyte abnormalities are the most common, but nephrotic syndrome, isolated proteinuria, and other syndromes can occur.
This topic will provide an overview of the major renal and electrolyte problems affecting patients with cancer and then direct the reader, when necessary, to more detailed discussions in other topics.
ACUTE AND CHRONIC KIDNEY DISEASE IN PATIENTS WITH CANCER
Renal function impairment in patients with cancer is often multifactorial. However, it is useful to divide the causes of kidney injury in such patients into three broad categories: prerenal; intrarenal; and postrenal (table 1) .
Prerenal disease — Volume depletion is a common complication in patients with cancer, typically due to the vomiting and diarrhea associated with chemotherapy (often combined with inadequate fluid intake). In addition, hypercalcemia associated with malignancy may exacerbate hypovolemia. (See "Clinical manifestations of hypercalcemia", section on 'Renal insufficiency'.)
Drugs used in patients with cancer may produce prerenal injury. Interleukin-2, for example, can cause a capillary leak syndrome, leading to a reduced effective circulating volume. Nonsteroidal anti-inflammatory drugs used to treat cancer pain may precipitate acute kidney injury in patients with a reduced effective circulating volume. (See "NSAIDs: Acute kidney injury (acute renal failure)", section on 'Mechanism of acute kidney injury' and "Immunotherapy of renal cell carcinoma", section on 'Toxicity'.)
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- ACUTE AND CHRONIC KIDNEY DISEASE IN PATIENTS WITH CANCER
- Prerenal disease
- Intrarenal disease
- - Glomerular diseases
- Membranous nephropathy
- Minimal change disease
- Amyloidosis and light chain deposition disease
- Proliferative/crescentic glomerulonephritis
- Bisphosphonate-associated collapsing FSGS
- - Tubulointerstitial diseases
- Chemotherapeutic drugs and zoledronate
- Myeloma cast nephropathy
- Tumor lysis syndrome
- Tumor infiltration
- - Vascular diseases
- Renal thrombotic microangiopathy
- Obstructive disease
- - Intratubular obstruction
- - Extrarenal obstruction
- ELECTROLYTE DISORDERS IN PATIENTS WITH CANCER
- Hyponatremia and hypernatremia
- Abnormalities in potassium balance
- Abnormalities in magnesium balance