Neoplasms and the Kidney

Abstract

Renal manifestations in neoplasm vary and depend on whether the neoplasm is primary or secondary. Manifestations generally are florid with secondary involvement of the kidneys, especially in acute leukemia, lymphoma, and myeloma. Clinically, there is microscopic or gross hematuria, mild to heavy proteinuria, renal tubular acidosis, and acute or chronic renal failure. These overt characteristics may be the result of renal interstitium infiltration by abnormal white blood cells (WBC); deposition of uric acid, calcium, or myeloma protein(s) in the tubules or interstitium; and/or chemotherapeutic agent toxicity. Some of the renal complications in malignancy are transient and cause slight concern, whereas others are persistent and of major importance. Among the renal complications, the most frequent nephrological consultation is done for progressive renal failure in patients with multiple myeloma. Twenty-five or thirty years ago, tumor lysis syndrome and acute uric acid nephropathy were common. Since the advent and use of allopurinol, acute urate nephropathy is rare, but acute renal failure (ARF) from sepsis or the effect of newer chemotherapeutic agents [cisplatinum, gallium, m-AMSA or amsacrine (acridinyl anisidide)] still occurs. The use of amsacrine tends to be a common reason for nephrological consultation.