Der Nephrologe

, Volume 5, Issue 1, pp 20–28 | Cite as

Maligne Erkrankungen und Nephropathie

Aktuelles zu Diagnostik, Prävention und Therapie
Leitthema
First Online:

Zusammenfassung

Maligne Erkrankungen und deren Behandlung werden oft durch Nierenerkrankungen kompliziert. Die Nierenfunktion sollte bei Erstdiagnose eines Malignoms sowie während der Therapie und der Nachsorge regelmäßig bestimmt werden. Das akute Nierenversagen (ANV) ist eine häufige Komplikation bei Malignompatienten und erhöht deren Mortalität. Die Ursachen für ein ANV sind multifaktoriell. Die meisten Komplikationen können mit Präventivmaßnahmen (z. B. Hydrierung und Harnsäuresenkung bei drohendem Tumorlysesyndrom, Meiden von Kontrastmitteln und nephrotoxischen Medikamenten, Dosisanpassung der Chemotherapeutika) verhindert werden oder sind bei prompter Diagnose und Behandlung reversibel. Hierfür ist die multidisziplinäre Zusammenarbeit von Nephrologen, Intensivmedizinern und Onkologen notwendig. Das multiple Myelom ist das am häufigsten zum terminalen Nierenversagen führende Malignom. Die Entfernung von Leichtketten durch Dialyse mit High-Cut-off (HCO)-Filtern als neue Therapieoption wird in Studien getestet. Ein Malignomscreening für Nierenpatienten ist vor allem bei Blasen- und Nierentumoren sowie nach Nierentransplantation indiziert.

Schlüsselwörter

Akutes Nierenversagen Rasburicase Bisphosphonate Tumorlysesyndrom Zytapherse 

Kidney disease and oncology

Current aspects of diagnostics, prevention and therapy

Abstract

Kidney disease frequently complicates nephrotic malignancy and its treatment. Kidney function should be assessed regularly with 24-h urine samples for measuring creatinine clearance of body surface area starting with the initial diagnosis of malignancy, and it should be continued during treatment and follow-up. Acute kidney injury (AKI) is a frequent serious oncological complication and increases mortality. Causes of AKI in cancer patients are multifactorial, and most are preventable or reversible with prompt diagnosis and treatment in a multidisciplinary setting, with e.g. hydration and reduction of uric acid in case of impending tumour lysis syndrome, avoidance of contrast agents, and adjustment of chemotherapy dosage. Of the causes of end-stage renal disease that are associated with malignancy, multiple myeloma is the most frequent. A new therapeutic option, HCO dialysis, is currently being tested in a random controlled trial. Screening for malignancy in kidney patients is indicated for bladder and kidney tumours and for skin malignancies and lymphoma in kidney transplant recipients.

Keywords

Acute kidney injury Rasburicase Bisphosphonates Tumour lysis syndrome Cytapheresis 
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Notes

Interessenkonflikt

Die Klinik für Nephrologie nimmt an der EuLITE-Studie der Fa. Gambro teil.

Literatur

  1. 1.
    Annemans L, Moeremans K, Lamotte M et al (2003) Incidence, medical resource utilisation and costs of hyperuricemia and tumour lysis syndrome in patients with acute leukaemia and non-Hodgkin’s lymphoma in four European countries. Leuk Lymphoma 44:77–83CrossRefPubMedGoogle Scholar
  2. 2.
    Benoit DD, Hoste EA, Depuydt PO et al (2005) Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies. Nephrol Dial Transplant 20:552–558CrossRefPubMedGoogle Scholar
  3. 3.
    Cairo MS, Bishop M (2004) Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 127:3–11CrossRefPubMedGoogle Scholar
  4. 4.
    Chertow GM, Paltiel AD, Owen WF Jr et al (1996) Cost-effectiveness of cancer screening in end-stage renal disease. Arch Intern Med 156:1345–1350CrossRefPubMedGoogle Scholar
  5. 5.
    Christensen EI, Birn H (2001) Megalin and cubilin: synergistic endocytic receptors in renal proximal tubule. Am J Physiol Renal Physiol 280:F562–F573PubMedGoogle Scholar
  6. 6.
    Clark WF, Stewart AK, Rock GA et al (2005) Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial. Ann Intern Med 143:777–784PubMedGoogle Scholar
  7. 7.
    Coiffier B, Altman A, Pui CH et al (2008) Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 26:2767–2778CrossRefPubMedGoogle Scholar
  8. 8.
    Darmon M, Ciroldi M, Thiery G et al (2006) Clinical review: specific aspects of acute renal failure in cancer patients. Crit Care 10:211CrossRefPubMedGoogle Scholar
  9. 9.
    Dash A, Galsky MD, Vickers AJ et al (2006) Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer 107:506–513CrossRefPubMedGoogle Scholar
  10. 10.
    Dogan E, Izmirli M, Ceylan K et al (2005) Incidence of renal insufficiency in cancer patients. Adv Ther 22:357–362CrossRefPubMedGoogle Scholar
  11. 11.
    Eremina V, Jefferson JA, Kowalewska J et al (2008) VEGF inhibition and renal thrombotic microangiopathy. N Engl J Med 358:1129–1136CrossRefPubMedGoogle Scholar
  12. 12.
    Farivar-Mohseni H, Perlmutter AE, Wilson S et al (2006) Renal cell carcinoma and end stage renal disease. J Urol 175:2018–2020; discussion 2021CrossRefPubMedGoogle Scholar
  13. 13.
    Galloway J (1922) Remarks on Hodgkin’s disease. BMJ 2:1201–1204CrossRefGoogle Scholar
  14. 14.
    Herget-Rosenthal S, Bokenkamp A, Hofmann W (2007) How to estimate GFR-serum creatinine, serum cystatin C or equations? Clin Biochem 40:153–161CrossRefPubMedGoogle Scholar
  15. 15.
    Herget-Rosenthal S, Kribben A, Pietruck F et al (1999) Two by two hour creatinine clearance–repeatable and valid. Clin Nephrol 51:348–354PubMedGoogle Scholar
  16. 16.
    Humphreys BD, Soiffer RJ, Magee CC (2005) Renal failure associated with cancer and its treatment: an update. J Am Soc Nephrol 16:151–161CrossRefPubMedGoogle Scholar
  17. 17.
    Hutchison CA, Cockwell P, Reid S et al (2007) Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies. J Am Soc Nephrol 18:886–895CrossRefPubMedGoogle Scholar
  18. 18.
    Hutchison CA, Cook M, Heyne N et al (2008) European trial of free light chain removal by extended haemodialysis in cast nephropathy (EuLITE): A randomised control trial. Trials 9:55CrossRefPubMedGoogle Scholar
  19. 19.
    Hutchison CA, Harding S, Hewins P et al (2008) Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease. Clin J Am Soc Nephrol 3:1684–1690CrossRefPubMedGoogle Scholar
  20. 20.
    Irish AB (2007) Myeloma and the kidney. In: Freehally J, Floege J, Johnson RJ (eds) Comprehensive clinical nephrology. Mosby Elsevier Philadelphia, pp 717–784Google Scholar
  21. 21.
    Kuhlmann U (2008) Nierenbeteiligung bei Systemerkrankungen. In: Kuhlmann U et al (Hrsg) Nephrologie. Thieme, Stuttgart, S 91–176Google Scholar
  22. 22.
    Lameire N (2007) The kidney in oncology. Acta Clin Belg 62:141–154PubMedGoogle Scholar
  23. 23.
    Lameire N, Adam A, Becker CR et al (2006) Baseline renal function screening. Am J Cardiol 98:21K–26KCrossRefPubMedGoogle Scholar
  24. 24.
    Lameire NH, Flombaum CD, Moreau D et al (2005) Acute renal failure in cancer patients. Ann Med 37:13–25CrossRefPubMedGoogle Scholar
  25. 25.
    Launay-Vacher V, Izzedine H, Rey JB et al (2004) Incidence of renal insufficiency in cancer patients and evaluation of information available on the use of anticancer drugs in renally impaired patients. Med Sci Monit 10:CR209–CR212PubMedGoogle Scholar
  26. 26.
    Levey AS, Atkins R, Coresh J et al (2007) Chronic kidney disease as a global public health problem: approaches and initiatives – a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 72:247–259CrossRefPubMedGoogle Scholar
  27. 27.
    Ljungberg B, Hanbury D, Kuczyk M et al (2009) Guidelines on Renal Cell Carcinoma. Online: http://www.uroweb.org (Stand: 07.12.2009)Google Scholar
  28. 28.
    Michallet AS, Tartas S, Coiffier B (2005) Optimizing management of tumor lysis syndrome in adults with hematologic malignancies. Support Cancer Ther 2:159–166CrossRefPubMedGoogle Scholar
  29. 29.
    Murray PT, Ratain MJ (2003) Estimation of the glomerular filtration rate in cancer patients: a new formula for new drugs. J Clin Oncol 21:2633–2635CrossRefPubMedGoogle Scholar
  30. 30.
    Novotny JR, Muller-Beissenhirtz H, Herget-Rosenthal S et al (2005) Grading of symptoms in hyperleukocytic leukaemia: a clinical model for the role of different blast types and promyelocytes in the development of leukostasis syndrome. Eur J Haematol 74:501–510CrossRefPubMedGoogle Scholar
  31. 31.
    Penfield JG (2006) Multiple myeloma in end-stage renal disease. Semin Dial 19:329–334PubMedGoogle Scholar
  32. 32.
    Pozzi C, D’Amico M, Fogazzi GB et al (2003) Light chain deposition disease with renal involvement: clinical characteristics and prognostic factors. Am J Kidney Dis 42:1154–1163CrossRefPubMedGoogle Scholar
  33. 33.
    Spinazze S, Schrijvers D (2006) Metabolic emergencies. Crit Rev Oncol Hematol 58:79–89CrossRefPubMedGoogle Scholar
  34. 34.
    Stewart JH, Buccianti G, Agodoa L et al (2003) Cancers of the kidney and urinary tract in patients on dialysis for end-stage renal disease: analysis of data from the United States, Europe, and Australia and New Zealand. J Am Soc Nephrol 14:197–207CrossRefPubMedGoogle Scholar
  35. 35.
    Thomas KW (2008) Reevaluating prognosis: cancer, septic shock, and changing outcomes. Crit Care Med 36:987–988CrossRefPubMedGoogle Scholar
  36. 36.
    Wright JG, Boddy AV, Highley M et al (2001) Estimation of glomerular filtration rate in cancer patients. Br J Cancer 84:452–459CrossRefPubMedGoogle Scholar
  37. 37.
    Zahran A, El-Husseini A, Shoker A (2007) Can cystatin C replace creatinine to estimate glomerular filtration rate? A literature review. Am J Nephrol 27:197–205CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für NephrologieUniversitätsklinikum EssenEssenDeutschland

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