Shahinian Vahakn B, Bahl Amit, Niepel Daniela, Lorusso Vito
Department of Internal Medicine, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA.
Bristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK.
Cancer Manag Res. 2017 May 16;9:167-178. doi: 10.2147/CMAR.S125864. eCollection 2017.
Renal function is an important consideration in the management of patients with advanced cancer. There is a reciprocal relationship between cancer and the kidney: chronic kidney disease can increase the risk of developing cancer, and patients with cancer often experience renal impairment owing to age, disease-related factors and nephrotoxic treatments. As therapies for cancer continue to improve, patients are living longer with their disease, potentially extending the period over which they are susceptible to long-term complications. Furthermore, secondary symptoms, such as bone metastases or infections, may arise that will require treatment. Certain treatments, including chemotherapy, antibiotics and some bone-targeted agents, are nephrotoxic and may require dose modifications or interruptions to prevent renal injury. Nephrologists should play a key role in the identification and management of renal impairment in patients with cancer. Furthermore, they may be able to provide advice on protecting the kidneys in instances where nephrotoxic agents require dose reductions or interruptions, and when novel therapies or combinations are used. Collaboration between oncologists and nephrologists is important to optimal patient management. This article reviews the relationship between cancer and kidney disease and examines the treatments that may impact kidney function. Considerations for monitoring renal function are also discussed.
在晚期癌症患者的管理中，肾功能是一个重要的考量因素。癌症与肾脏之间存在着相互关系：慢性肾脏病会增加患癌风险，而癌症患者常因年龄、疾病相关因素及肾毒性治疗而出现肾功能损害。随着癌症治疗方法不断改进，患者带病生存的时间更长，这可能会延长他们易发生长期并发症的时间段。此外，可能会出现如骨转移或感染等继发症状，需要进行治疗。某些治疗方法，包括化疗、抗生素和一些骨靶向药物，具有肾毒性，可能需要调整剂量或中断治疗以预防肾损伤。肾病学家在识别和管理癌症患者的肾功能损害方面应发挥关键作用。此外，在肾毒性药物需要减少剂量或中断治疗以及使用新疗法或联合疗法时，他们或许能够就肾脏保护提供建议。肿瘤学家和肾病学家之间的合作对于优化患者管理至关重要。本文回顾了癌症与肾脏疾病之间的关系，并探讨了可能影响肾功能的治疗方法。还讨论了监测肾功能的注意事项。
