Kidney disease frequently complicates malignancy and its treatment. The spectrum of disease in this setting includes acute renal failure (ARF), chronic renal failure, and tubular disorders. Fortunately, these complications are often preventable or reversible with prompt diagnosis and treatment
Causes of renal failure in cancer patients
| Prerenal |
| extracellular fluid depletion (poor intake, vomiting, diarrhea, hypercalcemia) |
| hepatorenal syndrome (veno-occlusive disease, hepatic resection) |
| drugs (calcineurin inhibitors, nonsteroidals) |
| Intrinsic |
| glomerular |
| membranous nephropathy |
| amyloidosis (multiple myeloma) |
| pamidronate-associated collapsing glomerulopathy (incidence unknown) |
| light-chain deposition disease |
| tubulointerstitial |
| acute tubular necrosis (toxic/ischemic) |
| lymphomatous infiltration of the kidney |
| light-chain deposition disease |
| drugs (cisplatin, ifosfamide) |
| intravenous contrast |
| cast nephropathy (multiple myeloma) |
| vascular |
| thrombotic-thrombocytopenic purpura/hemolytic- uremic syndrome (post-HCT, gemcitabine, mitomycin C) |
| tumor infiltration (renal cell carcinoma with renal vein thrombosis) |
| Postrenal |
| intratubular obstruction |
| uric acid nephropathy |
| methotrexate |
| cast nephropathy (multiple myeloma) |
| extrarenal obstruction |
| bladder outlet, ureteral (primary disease, retroperitoneal lymphadenopathy, retroperitoneal fibrosis) |