Krych M
Medizinische Klinik und Poliklinik III, Klinikum Grosshadern, Universität München.
Internist (Berl). 2005 Jan;46(1):30-8. doi: 10.1007/s00108-004-1316-2.
The acute renal failure is characterized by a rapid deterioration of the renal function. In addition to the usual prerenal, intrinsic and postrenal causes of an acute renal failure distinct causes have to be considered for oncological patients. Factors imminent to the malignant disease, e. g. paraneoplastic syndromes or retroperitoneal bulks can account for an acute renal failure. Paraproteins as produced by a multiple myeloma are other possible causes for renal dysfunction. For some anticancer drugs nephrotoxicity is a potential side effect, in particular for cisplatin, methotrexate, ifosfamide and melphalan. A hemolytic uremic syndrome may be induced by mitomycin and gemcitabine. Extensive surgery can be associated with rhabdomyolysis and myoglobinuria and results in renal impairment. Treatment of a chemosensitive neoplasia with a highly effective regimen may result in a tumor lysis syndrome with hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia.
急性肾衰竭的特点是肾功能迅速恶化。除了常见的急性肾衰竭的肾前性、肾性和肾后性病因外,肿瘤患者还必须考虑其他不同的病因。恶性疾病相关因素,如副肿瘤综合征或腹膜后肿块,可导致急性肾衰竭。多发性骨髓瘤产生的副蛋白是肾功能障碍的其他可能原因。对于某些抗癌药物,肾毒性是一种潜在的副作用,尤其是顺铂、甲氨蝶呤、异环磷酰胺和美法仑。丝裂霉素和吉西他滨可诱发溶血性尿毒症综合征。广泛的手术可能与横纹肌溶解和肌红蛋白尿有关,并导致肾功能损害。用高效方案治疗化疗敏感的肿瘤可能会导致肿瘤溶解综合征,出现高尿酸血症、高钾血症、高磷血症和低钙血症。