Acute kidney injury in cancer patients

César, Bruno Nogueira; Júnior, Marcelino de Souza Durão

doi:10.1590/1806-9282.66.s1.25

Cited by 9 publications

(8 citation statements)

References 27 publications

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“…Cancer patients are at high risk for the development of AKI (14)(15)(16)(17)(18)(19), which is related to the production of inflammatory cytokines and results in an increased mortality rate (19). In this study, the cancer patients that had concurrent AKI died in a very short time, and the mean survival time was only one week.…”

Section: Discussionmentioning

confidence: 70%

“…Production of inflammatory cytokines can be due to cancer itself or to responses of the patients to invasive procedures, therapies, or infections (11,20). Similarly, AKI in cancer patients can be secondary to cancer itself, driven by reactions of patients to bacterial infection, chemotherapy, or surgery (14)(15)(16). Half of our cases developed AKI due to other complications, such as septicemia or infection.…”

Section: Discussionmentioning

confidence: 92%

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Retrospective Analysis of Mortality Cases in Advanced and Metastatic Solid Tumors With Concurrent Prerenal Azotemia

Liao

Liaw

2020

In Vivo

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Background/Aim: A retrospective study of cases with metastatic or advanced solid tumors complicated with AKI (acute kidney injury) with prerenal azotemia. Patients and Methods: Criteria included: (1) advanced or metastatic solid tumors that led to mortality; (2) prerenal azotemia identified upon renal function evaluation and (3) BUN to Cr ratio (BCR)≥15. We also compared the outcomes of patients with BCR>20 with those of patients with BCR=15-20. Results: A total of 218 patients with solid tumors were enrolled. One hundred and forty (64%) and 78 (36%) patients had BCR>20 and 15-20, respectively. Before AKI occurrence, 136 (62%) had thromboembolic complications and 96 (44%) paraneoplastic syndromes. Median survival time was 1 week in all patients. Median survival time was statistically different between the groups with BCR15-20 and BCR>20 (p<0.005, log-rank test). Conclusion: Cancer patients with concurrent AKI and prerenal azotemia carry a very poor prognosis.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 92%

Retrospective Analysis of Mortality Cases in Advanced and Metastatic Solid Tumors With Concurrent Prerenal Azotemia

Liao

Liaw

2020

In Vivo

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“…Imaging usually provides a diagnosis. False-negative imaging in the evaluation of obstructive uropathy may be due to hypovolemia, partial obstruction, or renal entrapment secondary to RPF causing obstruction [ 24 ]. Further diagnostic evaluations may include cystoscopy and retrograde pyelogram.…”

Section: Discussionmentioning

confidence: 99%

Thinking Beyond Acute Kidney Injury

El-Alali

Moreno

Jaber

2022

Case Rep Nephrol Dial

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Acute kidney injury (AKI) can be a significant clue to solving a puzzling patient presentation. Postrenal AKI should be suspected if imaging shows any degree of hydronephrosis and can be caused by a variety of conditions. Diagnosis of urinary obstruction without significant dilatation of the pelvic-ureteral system requires a higher degree of suspicion, and hence, its identification can become late. In patients without prior cancer screening, the etiology of obstructive uropathy must be broadened to include primary or metastatic malignancy. Clinicians should look beyond the AKI to properly evaluate the etiology of the patient’s presentation and symptoms. In this report, we present the case of a middle-aged female with no known past medical history who presented with AKI secondary to malignant retroperitoneal fibrosis as the first manifestation of metastatic breast cancer. Her AKI was associated with acute onset anuria and was found to have nondilated postrenal AKI with no significant abnormalities on renal imaging. Early onset anuria in the setting of AKI, which persists despite fluid resuscitation, can suggest complete urinary tract obstruction even with reassuring results of initial renal images, and in the patient with no history of cancer screening, malignancy should be suspected as a primary cause of obstructive uropathy.

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“…Generally, patients with distant metastasis have a larger tumor burden and poorer performance status compared to those without distant metastasis. During treatment, patients with distant metastasis are more prone to have a low oral intake, therapy-induced nausea, vomiting, and diarrhea, all of which play a role in pre-renal renal dysfunction ( 12 , 13 ). These pre-renal factors, along with intrinsic factors (ICI therapy), predispose patients with distant metastasis to RAEs.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and prognostic role of renal adverse event in patients receiving immune checkpoint inhibitor therapy: analysis of data from a retrospective cohort study

Bao¹,

Liu²,

Xu³

et al. 2022

Ann Transl Med

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Background: Along with the widespread use of immune checkpoint inhibitors (ICIs), there has been a surge in immune-related adverse events which can limit the efficacy of ICIs. However, to date, there is a paucity of reports on renal adverse events (RAEs) related to ICIs. Therefore, this study reports the incidence, risk factors, pathological features of RAEs in patients receiving ICI therapy and its association with overall survival. Methods:The medical records of patients who received at least 1 cycle of anti-programmed death-1 (PD-1)/ programmed death ligand-1 (PD-L1) monoclonal antibody (mAb) between January 1st 2018 and July 31th 2021 were retrospectively reviewed. All available serum creatinine data were extracted and used to calculate the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) and RAEs were defined as a 25% decrease in eGFR from baseline.Logistic regression was used to analyze the risk factors for RAEs. The Kaplan-Meier method was used to compare the survival among patients with and without RAEs.Results: A total of 328 patients receiving ICI therapy were enrolled and 42 developed RAEs. Patients with RAEs had a lower median baseline acute monocyte count (AMC), higher median baseline ratio of lymphocyte and monocyte (LMR), were more likely to have hypertension, coronary heart disease, and distant metastasis, and were more likely to be receiving more cycles of ICI therapy. Multivariate analysis revealed that RAEs were associated with distant metastasis and the number of cycles of ICI therapy. RAEs were not associated with baseline creatinine, eGFR, ICI type, nor the line of ICI therapy. Regardless of whether patients were receiving first-line ICI therapy or non-first line ICI therapy, patients with RAEs had lower survival rates compared to patients without RAEs. Of the patients with RAEs, 2 received renal biopsies and were pathologically confirmed with acute interstitial nephritis (AIN).Conclusions: RAEs were not a rare complication in patients receiving ICIs treatment. Distant metastasis and the number of cycles of ICI therapy were associated with RAEs. Patients who developed RAEs were associated with worse survival.

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Acute kidney injury in cancer patients

Cited by 9 publications

References 27 publications

Retrospective Analysis of Mortality Cases in Advanced and Metastatic Solid Tumors With Concurrent Prerenal Azotemia

Retrospective Analysis of Mortality Cases in Advanced and Metastatic Solid Tumors With Concurrent Prerenal Azotemia

Thinking Beyond Acute Kidney Injury

Risk factors and prognostic role of renal adverse event in patients receiving immune checkpoint inhibitor therapy: analysis of data from a retrospective cohort study

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