Kidney and cancer - the basics

Kidney cancer is the third most common genitourinary cancer in adults.

  • Is there a link between CKD and cancer?
  • Yes, CKD is associated with neoplasms in several ways. Cancer can cause CKD in either direct or indirect ways, but CKD is also probably a risk factor for developing tumors. CKD is a condition that can complicate neoplastic disease as well as its treatment. Furthermore, pre-existing CKD is quite common in oncology patients. Moreover, pre-existing CKD in a neoplastic patient affects the use of anticancer drugs and their safety profile. In addition, CKD often restricts the use of some drugs, and makes it more difficult to use CT / MRI contrast agents.
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  • How close is this relationship?
  • More than half of patients with an active neoplastic disease exhibit a reduced glomerular filtration rate, e.g. chronic renal failure. In addition, CKD (moderate - severe stage) co - exists with neoplastic disease in a higher proportion in patients that suffer from neoplastic disease.
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  • Is kidney transplant related to neoplastic disease?
  • An additional correlation exists with kidney transplantation. Figures show that the risk for some form of neoplasm in kidney transplant patients is 2 or 3 times higher, and that 20-30% of the general population with CKD has a higher risk for some form of neoplasm for all types of cancers. Therefore, patients undergoing transplantation must perform a full and detailed check (pre-transplant control).
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  • What are the possible causes of CKD associated with cancer?
  • The possible causes that "associate" CKD with neoplastic disease are:
  • • antineoplastic drugs
  • • painkillers
  • • radiotherapy
  • • frequent use of contrast media
  • • paraneoplastic syndromes
  • • nephrectomy (due to neoplastic focus or other cause eg occlusion)
  • • obstruction from neoplastic mass
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  • Is there a relationship between kidney failure and antineoplastic drugs?
  • Several times, especially in the past, these drugs are associated with acute renal damage or CKD.
  • These can affect kidney function in four ways:
  • • directly damaging the kidneys
  • • indirectly because of side effects (dehydration, electrolyte disturbances)
  • • due to the serious infection they can cause and
  • • because of the sudden increase in uric acid that often created by some antineoplastic (chemotherapy) drugs.
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  • Are there risk factors that increase the relative risk of kidney damage in anyone treated with antineoplastic agents?
  • These are the same risk factors for kidney damage:
  • • pre-existing renal insufficiency
  • • diabetes mellitus
  • • heart failure
  • • hypertension
  • • use of other nephrotoxic drugs
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  • Is there such a great risk of kidney damage to someone who receives treatment for his cancer?
  • Fortunately, things have evolved. There are drugs much more targeted to the treatment of the cancer with fewer side effects. Oncologists are much more familiar with patients with kidney disease. Over the years, an informal industry has developed, that of "onco-nephrology", demonstrating the enormous importance the scientific community has in maintaining healthy kidney function. There are new, more sophisticated drugs, with well-known dosage regimen and a known way of adapting their dose depending on the kidney function, have been developed "preparation" protocols of the CKD patient to minimize the possible side effects of such drugs, early identification of possible complications and of course their immediate treatment. This complex safety net is designed to provide the patient the best treatment for his problem by minimizing the likelihood of developing or worsening renal insufficiency. Patients with neoplasms are patients with multidimensional problems. The treatment of the underlying disease must be made with respect to the patient's coexisting problems, when physicians, for the benefit of patients, become more aware and familiar with the problems arising from the coexistence of neoplasia and CKD.
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  • Mesogeios Dialysis Centers Group Scientific Team
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  • Bibliography 
  • 1.Torres da Costa E Silva V, Costalonga EC, Coelho FO, Caires RA, Burdmann EA. Assessment of Kidney Function in Patients with Cancer. Adv Chronic Kidney Dis. 2018 Jan;25(1):49-56. doi: 10.1053/j.ackd.2017.10.010. Review.
  • 2.Horie S, Oya M, Nangaku M, Yasuda Y, Komatsu Y, Yanagita M, Kitagawa Y, Kuwano H, Nishiyama H, Ishioka C, Takaishi H, Shimodaira H, Mogi A, Ando Y, Matsumoto K, Kadowaki D, Muto S. Guidelines for treatment of renal injury during cancer chemotherapy 2016. Clin Exp Nephrol. 2018 Feb;22(1):210-244. doi: 10.1007/s10157-017-1448-z. Review.
  • 3.Hu SL, Chang A, Perazella MA, Okusa MD, Jaimes EA, Weiss RH; American Society of Nephrology Onco-Nephrology Forum. The Nephrologist's Tumor: Basic Biology and Management of Renal Cell Carcinoma. J Am Soc Nephrol. 2016 Aug;27(8):2227-37. doi: 10.1681/ASN.2015121335. Epub 2016 Mar 9. Review. PubMed PMID: 26961346.
  • 4.Hassan Izzedine, Mark A. Perazella; Onco-nephrology: an appraisal of the cancer and chronic kidney disease links, Nephrology Dialysis Transplantation, Volume 30, Issue 12, 1 December 2015, Pages 1979–1988.
  • 5.U.S. Renal Data System. USRDS 2003 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, 2003.
  • 6.Kapoor M, Chan GZ: Malignancy and renal disease. Crit Care Clin 17: 571–598, viii, 2001
  • 7.da Silva J, Mesler D. Acute renal failure as a result of malignancy. In: Acute Renal Failure: A Companion to Brenner and Rector’s The Kidney, edited by Molitoris B, Finn W, Indianapolis, Harcourt, 2001, pp 312–321.
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