Braet Pauline, Sartò Giulia Vanessa Re, Pirovano Marta, Sprangers Ben, Cosmai Laura
Division of Nephrology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy.
Clin Kidney J. 2021 Dec 24;15(5):873-884. doi: 10.1093/ckj/sfab292. eCollection 2022 May.
Acute kidney injury (AKI), either of pre-renal, renal or post-renal origin, is an important complication in cancer patients, resulting in worse prognosis, withdrawal from effective oncological treatments, longer hospitalizations and increased costs. The aim of this article is to provide a literature review of general and cause-specific treatment strategies for AKI, providing a helpful guide for clinical practice. We propose to classify AKI as patient-related, cancer-related and treatment-related in order to optimize therapeutic interventions. In the setting of patient-related causes, proper assessment of hydration status and avoidance of concomitant nephrotoxic medications is key. Cancer-related causes mainly encompass urinary compression/obstruction, direct tumoural kidney involvement and cancer-induced hypercalcaemia. Rapid recognition and specific treatment can potentially restore renal function. Finally, a pre-treatment comprehensive evaluation of risks and benefits of each treatment should always be performed to identify patients at high risk of treatment-related renal damage and allow the implementation of preventive measures without losing the potentialities of the oncological treatment. Considering the complexity of this field, a multidisciplinary approach is necessary with the goal of reducing the incidence of AKI in cancer patients and improving patient outcomes. The overriding research goal in this area is to gather higher quality data from international collaborative studies.
急性肾损伤（AKI），无论是肾前性、肾性还是肾后性起源，都是癌症患者的重要并发症，会导致预后更差、中断有效的肿瘤治疗、住院时间延长和费用增加。本文旨在对AKI的一般治疗策略和特定病因治疗策略进行文献综述，为临床实践提供有益指导。我们建议将AKI分为与患者相关、与癌症相关和与治疗相关三类，以优化治疗干预措施。在与患者相关的病因方面，正确评估水化状态并避免使用伴随的肾毒性药物是关键。与癌症相关的病因主要包括尿路压迫/梗阻、肿瘤直接侵犯肾脏和癌症引起的高钙血症。快速识别和特异性治疗有可能恢复肾功能。最后，应始终对每种治疗的风险和益处进行治疗前综合评估，以识别有治疗相关肾损伤高风险的患者，并在不丧失肿瘤治疗潜力的情况下实施预防措施。鉴于该领域的复杂性，需要采取多学科方法，目标是降低癌症患者AKI的发生率并改善患者预后。该领域首要的研究目标是从国际合作研究中收集更高质量的数据。
