Lameire Norbert, Van Biesen Wim, Vanholder Raymond
Renal Division of Nephrology, University Hospital Gent, Gent, Belgium.
Curr Opin Crit Care. 2008 Dec;14(6):635-46. doi: 10.1097/MCC.0b013e32830ef70b.
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.
本综述探讨了危重症癌症患者肾脏问题管理中的三个主要主题；癌症患者的肾功能评估、严重的水和电解质代谢紊乱以及血液系统和非血液系统恶性肿瘤继发的急性肾损伤。
在所有癌症患者初次就诊时、开始和改变癌症治疗时以及随访期间，都应检测肾功能（通过尿分析检测蛋白尿或白蛋白尿以及血清肌酐来估计肾小球滤过率）。然而，在使用不同的肾小球滤过率估算公式时应谨慎。与再喂养综合征相关的电解质异常很常见，但却未得到充分认识，通常发生在接受静脉或肠内营养的急性病、营养不良的住院患者中。目前关于急性肾损伤及其后果的数据表明，急性肾损伤有可能显著改变癌症患者的预后，并危及他们接受最佳癌症治疗和潜在治愈的机会。
危重症癌症患者众多肾脏并发症的复杂管理需要多学科方法，其中肾病学家、重症监护医生和肿瘤学家都起着关键作用。
