Onconephrology: Acute kidney injury in cancer patients

Abstract

Acute kidney injury (AKI) is a common complication of cancer, occurring in up to 50% of neoplastic patients during the natural course of their disease. Furthermore, it has a significant impact on key outcomes, such as overall prognosis, length of hospitalization, and costs. AKI in cancer patients has various causes, including patient-related, tumor-related, or treatment-related factors. Patient-related risk factors for AKI are similar to those in the general population. Tumor-related risk factors can involve compression, obstruction, direct kidney infiltration by the tumor, as well as precipitation, aggregation, crystallization, or misfolding of paraproteins in conditions like multiple myeloma. Treatment-related risk factors are the most commonly observed in clinical practice and can present as features of tumor lysis syndrome or, for example, immune checkpoint inhibitor-related AKI. In the absence of validated biomarkers for AKI, a multidisciplinary clinical approach involving oncologists, intensivists, nephrologists, or onconephrologists is essential. This approach incorporates thorough assessment, the use of appropriate preventive measures, and early intervention to reduce the incidence of AKI in cancer patients. Understanding the essence of preventive measures, timely initiation of treatment, and knowing when to terminate treatment will reduce the frequency of this life-threatening condition and improve the effectiveness of cancer treatment and the quality of life and life expectancy of cancer patients. This work aims to improve physicians' awareness of the latest data on the prevention, diagnosis, and treatment of AKI specifically related to oncopathology, tumor lysis syndrome, and acute kidney injury induced by cancer immunotherapy drugs.