Acute Renal Failure in Critically Ill Cancer Patients

  • Aisha Khattak
  • Kevin W. FinkelEmail author
Reference work entry


Acute kidney injury remains a common complication in patients with cancer and is associated with increased length of stay, cost, and mortality. Furthermore, acute kidney injury can also lead to impaired functional status, decreased quality of life, and exclusion from further cancer therapy or trials. Patients with cancer are at risk for developing acute kidney injury from etiologies common to all hospitalized patients such as sepsis or exposure to nephrotoxic agents, including radiocontrast and antibiotics. In addition, acute kidney injury in these patients may be due to direct injury from the underlying malignancy (e.g., lymphomatous infiltration), chemotherapy toxicity (e.g., acute tubular necrosis), effects of hematopoietic stem cell transplantation, or from treatment complications (e.g., tumor lysis syndrome). Patient-related risk factors for acute kidney injury include older age, female gender, underlying chronic kidney disease, diabetes mellitus, volume depletion, and renal hypoperfusion. While cancer itself is not a contraindication for starting renal replacement therapy, the benefits of renal replacement therapy must be weighed against the overall prognosis of the patient and quality of life. A multidisciplinary discussion between the patient, nephrologist, oncologist, intensivist, and palliative care physicians is often necessary to make an informed clinical decision.


Acute kidney injury Chemotherapy Tumor lysis Bone marrow transplantation Thrombotic microangiopathy Renal replacement therapy Multiple myeloma Cast nephropathy Renal cell cancer Targeted therapy Immunotherapy 


  1. 1.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative Workgroup. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute Dialysis quality initiative (ADQI) group. Crit Care. 2004;8:R204–12.CrossRefGoogle Scholar
  2. 2.
    Mehta RL, Kellum JA, Shah SV, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.CrossRefGoogle Scholar
  3. 3.
    The KDIGO Working Group. Section 2: AKI definition. Kidney Int Suppl (2011). 2012;2: 19–36.Google Scholar
  4. 4.
    Meersch M, Schmidt C, Hoffmeier A, et al. Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med. 2017;43:1551–61.CrossRefGoogle Scholar
  5. 5.
    Christiansen CF, Johansen MB, Langeberg WJ, Fryzek JP, Sorensen HT. Incidence of acute kidney injury in cancer patients: a Danish population-based cohort study. Eur J Intern Med. 2011;22:399–406.CrossRefGoogle Scholar
  6. 6.
    Salahudeen AK, Doshi SM, Pawar T, Nowshad G, Lahoti A, Shah P. Incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a comprehensive cancer center. Clin J Am Soc Nephrol. 2013;8:347–54.CrossRefGoogle Scholar
  7. 7.
    Benoit DD, Hoste EA. Acute kidney injury in critically ill patients with cancer. Crit Care Clin. 2010;26:151–79.CrossRefGoogle Scholar
  8. 8.
    Kemlin D, Biard L, Kerhuel L, et al. Acute kidney injury in critically ill patients with solid tumours. Nephrol Dial Transplant. 2018;33:1997–2005.CrossRefGoogle Scholar
  9. 9.
    Network VNARFT, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.CrossRefGoogle Scholar
  10. 10.
    Uchino S, Bellomo R, Kellum JA, et al. Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury. Int J Artif Organs. 2007;30:281–92.CrossRefGoogle Scholar
  11. 11.
    Darmon M, Vincent F, Canet E, et al. Acute kidney injury in critically ill patients with haematological malignancies: results of a multicentre cohort study from the Groupe de Recherche en reanimation Respiratoire en Onco-Hematologie. Nephrol Dial Transplant. 2015;30:2006–13.CrossRefGoogle Scholar
  12. 12.
    van Vliet M, Verburg IW, van den Boogaard M, et al. Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units. Intensive Care Med. 2014;40:1275–84.CrossRefGoogle Scholar
  13. 13.
    Rabe C, Mey U, Paashaus M, et al. Outcome of patients with acute myeloid leukemia and pulmonary infiltrates requiring invasive mechanical ventilation-a retrospective analysis. J Crit Care. 2004;19:29–35.CrossRefGoogle Scholar
  14. 14.
    Lahoti A, Kantarjian H, Salahudeen AK, et al. Predictors and outcome of acute kidney injury in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome. Cancer. 2010;116: 4063–8.CrossRefGoogle Scholar
  15. 15.
    Tornroth T, Heiro M, Marcussen N, Franssila K. Lymphomas diagnosed by percutaneous kidney biopsy. Am J Kidney Dis. 2003;42:960–71.CrossRefGoogle Scholar
  16. 16.
    Bach AG, Behrmann C, Holzhausen HJ, et al. Prevalence and patterns of renal involvement in imaging of malignant lymphoproliferative diseases. Acta Radiol. 2012;53:343–8.CrossRefGoogle Scholar
  17. 17.
    Hutchison CA, Cockwell P, Stringer S, et al. Early reduction of serum-free light chains associates with renal recovery in myeloma kidney. J Am Soc Nephrol. 2011;22:1129–36.CrossRefGoogle Scholar
  18. 18.
    Moreau P, Richardson PG, Cavo M, et al. Proteasome inhibitors in multiple myeloma: 10 years later. Blood. 2012;120:947–59.CrossRefGoogle Scholar
  19. 19.
    Jodele S, Licht C, Goebel J, et al. Abnormalities in the alternative pathway of complement in children with hematopoietic stem cell transplant-associated thrombotic microangiopathy. Blood. 2013;122:2003–7.CrossRefGoogle Scholar
  20. 20.
    Jodele S, Laskin BL, Dandoy CE, et al. A new paradigm: diagnosis and management of HSCT-associated thrombotic microangiopathy as multi-system endothelial injury. Blood Rev. 2015;29:191–204.CrossRefGoogle Scholar
  21. 21.
    Parikh CR, McSweeney PA, Korular D, et al. Renal dysfunction in allogeneic hematopoietic cell transplantation. Kidney Int. 2002;62:566–73.CrossRefGoogle Scholar
  22. 22.
    Parikh CR, Sandmaier BM, Storb RF, et al. Acute renal failure after nonmyeloablative hematopoietic cell transplantation. J Am Soc Nephrol. 2004;15:1868–76.CrossRefGoogle Scholar
  23. 23.
    Parikh CR, Schrier RW, Storer B, et al. Comparison of ARF after myeloablative and nonmyeloablative hematopoietic cell transplantation. Am J Kidney Dis. 2005;45:502–9.CrossRefGoogle Scholar
  24. 24.
    Parikh CR, Yarlagadda SG, Storer B, Sorror M, Storb R, Sandmaier B. Impact of acute kidney injury on long-term mortality after nonmyeloablative hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2008;14:309–15.CrossRefGoogle Scholar
  25. 25.
    Lam AQ, Humphreys BD. Onco-nephrology: AKI in the cancer patient. Clin J Am Soc Nephrol. 2012;7:1692–700.CrossRefGoogle Scholar
  26. 26.
    DeLeve LD, McCuskey RS, Wang X, et al. Characterization of a reproducible rat model of hepatic veno-occlusive disease. Hepatology. 1999;29:1779–91.CrossRefGoogle Scholar
  27. 27.
    Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011;364:1844–54.CrossRefGoogle Scholar
  28. 28.
    Jeha S, Pui CH. Recombinant urate oxidase (rasburicase) in the prophylaxis and treatment of tumor lysis syndrome. Contrib Nephrol. 2005;147: 69–79.PubMedGoogle Scholar
  29. 29.
    Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26:2767–78.CrossRefGoogle Scholar
  30. 30.
    Schmid M, Krishna N, Ravi P, et al. Trends of acute kidney injury after radical or partial nephrectomy for renal cell carcinoma. Urol Oncol. 2016;34:293 e1–e10.CrossRefGoogle Scholar
  31. 31.
    Schmid M, Abd-El-Barr AE, Gandaglia G, et al. Predictors of 30-day acute kidney injury following radical and partial nephrectomy for renal cell carcinoma. Urol Oncol. 2014;32:1259–66.CrossRefGoogle Scholar
  32. 32.
    Wysolmerski JJ, Broadus AE. Hypercalcemia of malignancy: the central role of parathyroid hormone-related protein. Annu Rev Med. 1994;45:189–200.CrossRefGoogle Scholar
  33. 33.
    Seymour JF, Gagel RF. Calcitriol: the major humoral mediator of hypercalcemia in Hodgkin’s disease and non-Hodgkin’s lymphomas. Blood. 1993;82:1383–94.PubMedGoogle Scholar
  34. 34.
    LeGrand SB, Leskuski D, Zama I. Narrative review: furosemide for hypercalcemia: an unproven yet common practice. Ann Intern Med. 2008;149:259–63.CrossRefGoogle Scholar
  35. 35.
    Fleisch H. Bisphosphonates. Pharmacology and use in the treatment of tumour-induced hypercalcaemic and metastatic bone disease. Drugs. 1991;42:919–44.CrossRefGoogle Scholar
  36. 36.
    Binstock ML, Mundy GR. Effect of calcitonin and glutocorticoids in combination on the hypercalcemia of malignancy. Ann Intern Med. 1980;93:269–72.CrossRefGoogle Scholar
  37. 37.
    Castellano D, Sepulveda JM, Garcia-Escobar I, Rodriguez-Antolin A, Sundlov A, Cortes-Funes H. The role of RANK-ligand inhibition in cancer: the story of denosumab. Oncologist. 2011;16:136–45.CrossRefGoogle Scholar
  38. 38.
    Jiang M, Wang CY, Huang S, Yang T, Dong Z. Cisplatin-induced apoptosis in p53-deficient renal cells via the intrinsic mitochondrial pathway. Am J Physiol Renal Physiol. 2009;296:F983–93.CrossRefGoogle Scholar
  39. 39.
    Motwani SS, McMahon GM, Humphreys BD, Partridge AH, Waikar SS, Curhan GC. Development and validation of a risk prediction model for acute kidney injury after the first course of cisplatin. J Clin Oncol. 2018;36:682–8.CrossRefGoogle Scholar
  40. 40.
    Patzer L, Hernando N, Ziegler U, Beck-Schimmer B, Biber J, Murer H. Ifosfamide metabolites CAA, 4-OH-Ifo and Ifo-mustard reduce apical phosphate transport by changing NaPi-IIa in OK cells. Kidney Int. 2006;70:1725–34.CrossRefGoogle Scholar
  41. 41.
    Oberlin O, Fawaz O, Rey A, et al. Long-term evaluation of Ifosfamide-related nephrotoxicity in children. J Clin Oncol. 2009;27:5350–5.CrossRefGoogle Scholar
  42. 42.
    Izzedine H, Escudier B, Lhomme C, et al. Kidney diseases associated with anti-vascular endothelial growth factor (VEGF): an 8-year observational study at a single center. Medicine (Baltimore). 2014;93: 333–9.CrossRefGoogle Scholar
  43. 43.
    Usui J, Glezerman IG, Salvatore SP, Chandran CB, Flombaum CD, Seshan SV. Clinicopathological spectrum of kidney diseases in cancer patients treated with vascular endothelial growth factor inhibitors: a report of 5 cases and review of literature. Hum Pathol. 2014;45:1918–27.CrossRefGoogle Scholar
  44. 44.
    Ha SH, Park JH, Jang HR, et al. Increased risk of everolimus-associated acute kidney injury in cancer patients with impaired kidney function. BMC Cancer. 2014;14:906.CrossRefGoogle Scholar
  45. 45.
    Porta C, Cosmai L, Gallieni M, Pedrazzoli P, Malberti F. Renal effects of targeted anticancer therapies. Nat Rev Nephrol. 2015;11:354–70.CrossRefGoogle Scholar
  46. 46.
    Jhaveri KD, Sakhiya V, Fishbane S. Nephrotoxicity of the BRAF inhibitors vemurafenib and dabrafenib. JAMA Oncol. 2015;1:1133–4.CrossRefGoogle Scholar
  47. 47.
    Shalmi CL, Dutcher JP, Feinfeld DA, et al. Acute renal dysfunction during interleukin-2 treatment: suggestion of an intrinsic renal lesion. J Clin Oncol. 1990;8: 1839–46.CrossRefGoogle Scholar
  48. 48.
    Cortazar FB, Marrone KA, Troxell ML, et al. Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors. Kidney Int. 2016;90:638–47.CrossRefGoogle Scholar
  49. 49.
    Wanchoo R, Karam S, Uppal NN, et al. Adverse renal effects of immune checkpoint inhibitors: a narrative review. Am J Nephrol. 2017;45:160–9.CrossRefGoogle Scholar
  50. 50.
    Jhaveri KD, Wanchoo R, Sakhiya V, Ross DW, Fishbane S. Adverse renal effects of novel molecular oncologic targeted therapies: a narrative review. Kidney Int Rep. 2017;2:108–23.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Renal Diseases and HypertensionUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Department of Medicine, Division of Renal Diseases and HypertensionUTHealth Science Center at Houston–McGovern Medical SchoolHoustonUSA

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