Overview of acute renal manifestations in cancer patients

2020 ◽  
Vol 19 (1) ◽  
pp. 34-41
Author(s):  
Zay Htet ◽  
◽  
Hannah Stacey ◽  
Mahzuz Karim ◽  
◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Acute Care ◽  
Kidney Injury ◽  
Significant Morbidity ◽  
Contributing Factors ◽  
Initial Management ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Prolonged Hospitalization

Acute kidney injury is frequently encountered in patients with malignancy and is associated with prolonged hospitalization, significant morbidity, and increased mortality. Thorough evaluation is required to identify possible contributing factors, which may range from relatively easily reversible pre-renal causes to complex cancer-specific aetiologies. This review will serve as a practical guide for acute care physicians on the acute medical unit to the assessment and initial management of cancer patients presenting with acute kidney injury.

Acute kidney injury in the cancer patient

2015 ◽  
Author(s):  
Gilbert W. Moeckel ◽  
Veena Manjunath ◽  
Mark A. Perazella
Keyword(s):  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Presentation ◽  
Kidney Tissue ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Direct Effects ◽  
Significant Morbidity ◽  
Adequate Treatment ◽  
Kidney Lesions

Acute kidney injury in cancer patients is a complicated clinical condition associated with significant morbidity and mortality, especially in the hospital setting. Cancer patients may develop a variety of different kidney lesions that impair not only immediate survival but also limit the adequate treatment of the underlying malignant process. This poses a significant challenge for clinicians.The mechanisms that lead to acute kidney injury in cancer patients are similar to those seen in non-cancer patients. Moreover, significant morbidity is seen in association with chemotherapy, as well as through direct effects of the cancer on the kidney (i.e. obstruction, infiltrate).This chapter reviews the clinical presentation of the most common malignancies that affect the kidney, discusses their pathologic manifestations in kidney tissue, and reviews options for the clinical management of cancer patients with acute kidney injury.

scholarly journals Care bundles for acute kidney injury: a balanced accounting of the impact of implementation in an acute medical unit

2018 ◽  
Vol 7 (4) ◽  
pp. e000392 ◽  
Author(s):  
Rachael Logan ◽  
Peter Davey ◽  
Alison Davie ◽  
Suzanne Grant ◽  
Vicki Tully ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Patient Safety ◽  
Good Practice ◽  
Kidney Injury ◽  
Care Bundle ◽  
Simple Task ◽  
Care Bundles ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
The Impact

In 2009, a National Confidential Enquiry into Patient Outcome and Death report detailed significant shortcomings in recognition and management of patients with acute kidney injury (AKI). As part of a national collaborative to reduce harm from AKI, the Scottish Patient Safety Programme developed two care bundles to improve response (‘SHOUT’) and review (‘BUMP’) of AKI.Baseline data from eight patients with AKI on the acute medical unit (AMU) in Ninewells Hospital showed 62% compliance with SHOUT. However, most patients were transferred from AMU within 24 hours so BUMP could not be assessed. Our aim was to achieve >95% compliance with SHOUT on AMU within 2 months. The content of the SHOUT bundle was condensed onto a sticker for the case notes, which was implemented using Plan-Do-Study-Act cycles. Compliance was assessed weekly and feedback obtained from stakeholders concerning their opinion of the sticker, SHOUT bundle and care bundles in general.Use of the sticker was 27% in week 1 but fell to 5% by week 4. Compliance with the bundle varied from 45% to 60% and was only slightly improved by use of the sticker (OR 1.58, 95% CI 0.39 to 6.42). Staff found the sticker burdensome and did not agree that all elements of SHOUT were equally important. This opinion was supported by finding that their compliance with sepsis and hypovolaemia recommendations was 91%–100% throughout, whereas urinalysis was documented in only 55%–63% of patients. Several staff mentioned ‘bundle fatigue’ and on one day we identified 22 other care bundles or structured improvement forms in AMU.We concluded that the AMU staff had legitimate concerns about the SHOUT care bundle and that our intervention was demotivating. Overcoming bundle fatigue will not be a simple task. We plan to work with staff on integrating AKI into patient safety huddles and on using modelling and recognition of good practice to improve motivation.

KIDNEY INJURY IN CANCER THERAPY

2018 ◽  
Vol 22 (5) ◽  
pp. 17-24 ◽  
Author(s):  
E. V. Burnasheva ◽  
Y. V. Shatokhin ◽  
I. V. Snezhko ◽  
A. A. Matsuga
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Cytotoxic Effect ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Chemotherapeutic Agents ◽  
Oxygen Intermediates ◽  
Circulating Blood Volume

Кidney injury is a frequent and significant complication of cancer and cancer therapy. The kidneys are susceptible to injury from malignant infiltration, damage by metabolites of malignant cells, glomerular  injury, nephrotoxic drugs including chemotherapeutic agents. Also  bone marrow transplantation complications, infections with immune  suppression (including septicemia), tumor lysis syndrome should be  taken into account. Chemotherapeutic agents are a common cause  of acute kidney injury but can potentially lead to chronic kidney  disease development in cancer patients. This article summarizes risk  factors of acute kidney injury in cancer patients. Risk factors are  divided into two groups. The systemic are decrease of total  circulating blood volume, infiltration of kidney tissue by tumor cells,  dysproteinemia, electrolyte disturbances. The local (renal) risk  factors are microcirculation disturbances, drugs biotransformation  with formation of reactive oxygen intermediates, high concentration of nephrotoxic agents in proximal tubules and its  sensitivity to ischemia. Drug-related risk factors include: drugs  combination with cytotoxic effect high doses long term use necessity, direct cytotoxic effect of not only chemotherapeutic agents but also its metabolites, mean solubility forming intratubular  precipitates. Early diagnosis, timely prevention and treatment of  these complications provide significantly improve nononcologic results of treatment.

scholarly journals Epidemiology and outcomes of acute kidney injury in hospitalized cancer patients in China

2019 ◽  
Vol 144 (11) ◽  
pp. 2644-2650 ◽  
Author(s):  
Yichun Cheng ◽  
Sheng Nie ◽  
Lu Li ◽  
Yanqin Li ◽  
Diankun Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Kidney Injury

scholarly journals Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery

2012 ◽  
Vol 3 (4) ◽  
pp. 278 ◽  
Author(s):  
Xue-zhong Xing ◽  
Hai-jun Wang ◽  
Chu-lin Huang ◽  
Quan-hui Yang ◽  
Shi-ning Qu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cancer Patients ◽  
Critically Ill ◽  
Injury Risk ◽  
Kidney Injury ◽  
Risk Scores

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

scholarly journals Acute kidney injury and its outcome in obstetrics

2020 ◽  
Vol 9 (6) ◽  
pp. 2508
Author(s):  
Dipal C. Shah ◽  
Babulal S. Patel ◽  
Akshay C. Shah ◽  
Shashwat K. Jani ◽  
Saumya P. Agrawal ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Placenta Previa ◽  
Kidney Injury ◽  
Causative Factor ◽  
Loss Of Function ◽  
Contributing Factors ◽  
Early Management ◽  
Study Association ◽  
Stage Renal Disease ◽  
End Stage

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).

scholarly journals Acute kidney injury in cancer patients: A nationwide survey in China

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Juan Jin ◽  
Yafang Wang ◽  
Quanquan Shen ◽  
Jianguang Gong ◽  
Li Zhao ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Kidney Injury ◽  
Nationwide Survey

Assessment and initial management of acute kidney injury

Medicine ◽  
2011 ◽  
Vol 39 (7) ◽  
pp. 390-397 ◽  
Author(s):  
Laura Griffiths ◽  
Nigel Suren Kanagasundaram
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Initial Management
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