Acute renal problems in the critically ill cancer patient.
OBJECTIVE
This review addresses three major topics relevant for the management of renal problems in the critically ill cancer patient; the assessment of kidney function in patients with cancer, serious water and electrolyte metabolism disturbances and acute kidney injury secondary to hematological and nonhematological malignancies.


RESULTS
In all cancer patients, renal function (urinalysis for proteinuria or albuminuria and serum creatinine to estimate glomerular filtration rate) should be tested when they first present, at initiation and change of cancer therapy as well as during follow-up. However, the different proposed formulae for estimation of the glomerular filtration rate should be used with caution. Electrolyte abnormalities associated with the refeeding syndrome are common, yet underappreciated, and occur typically in acutely ill, malnourished hospitalized patients who are administered intravenous or enteral nutrition. Currently available data on acute kidney injury and its consequences suggest that acute kidney injury has the potential to substantially alter the outcome of patients with cancer and jeopardize their chances of receiving optimal cancer treatment and a potential cure.


CONCLUSIONS
The complex management of the numerous renal complications of the critically ill cancer patient needs a multidisciplinary approach in which the nephrologist, intensivist and oncologist all play a pivotal role.
Lameire
Norbert
N
Renal Division of Nephrology, University Hospital Gent, Gent, Belgium. norbert.lameire@ugent.be
Van Biesen
Wim
W
Vanholder
Raymond
R
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016638:Critical Illness; D004573:Electrolytes; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology; D015275:Tumor Lysis Syndrome; D014481:United States / Q000453:epidemiology
D004573:Electrolytes