Renal Division of Nephrology, University Hospital Gent, Gent, Belgium.

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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.

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.

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.

Written by:
Lameire N, Van Biesen W, Vanholder R.   Are you the author?

Reference:
Curr Opin Crit Care. 2008 Dec;14(6):635-46.

PubMed Abstract
PMID:19005304

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