Beware of acute kidney failure due to cancer

Acute renal failure is a syndrome manifested by a rapid decrease in glomerular filtration rate from a few hours to several days, leading to an acute increase in blood urea and creatinine concentrations. Acute kidney failure due to cancer is often a medical condition and increases the mortality rate for patients if not detected and treated promptly.

Acute renal failure is a syndrome characterized by a rapid decrease in glomerular filtration rate over a period of hours to days. From there, it leads to an acute increase in blood urea and creatinine levels, causing water retention and acid-base imbalance disorder. Acute renal failure due to cancer is often in the context of serious medical conditions and is caused by the malignancy itself. The disease increases mortality if not detected and treated promptly.
Acute kidney failure due to cancer causes the following symptoms:
Stage 1: symptoms develop within 24 hours such as little urine, even anuria, if timely intervention can reduce the risk of turning to cancer. stage 2.
Stage 2: Full-blown phase
Lasts from 1-6 weeks, on average after 7-14 days the patient will urinate again. Oliguria, anuria, and edema. Blood urea and creatinine rise rapidly Hyperkalemia Water and electrolyte disturbances. Metabolic acidosis: blood pH decreases, HC0- decreases. Stage 3: Return to urination, takes place on average from 5-7 days
Urine comes back with the amount starting from 200-300ml/24 hours, can urinate 4-5 liters/24 hours. High risks such as: uremia, hyperkalemia, polyuria, water and electrolyte disturbances. Stage 4: Recovery, lasts about 4 weeks on average.

Subclinical tests to diagnose acute kidney failure due to cancer include:
Blood tests: increased blood creatinine, increased blood urea, rapidly increased blood potassium and possibly increased blood calcium. Arterial blood gas testing: severe metabolic acidosis with manifestations such as decreased pH, decreased HCO. Urinalysis: changes in urinary electrolytes, urinary urea, creatinine in urine, white blood cell casts, red blood cell casts,... Other tests such as CT scan, ultrasound, abdominal MRI or whole PET/CT body to find invasive tumor lesions causing renal failure. Functional kidney scintigraphy by SPECT, gamma camera: helps to assess perfusion and glomerular filtration function or post-renal obstruction.

Prerenal acute renal failure
Decreased circulating volume: common due to gastrointestinal bleeding in cancers of the gastrointestinal tract, liver, pancreas,... Patients have symptoms such as dehydration, blood loss and body fluids through the digestive tract. Loss of fluid into the third compartment in the following cases: poor nutrition, liver cancer, after tumor surgery, hypoalbuminemia in debilitated patients, patients with postoperative catheters, lymphomas, malignant tumors Hematologic properties,... Loss of fluid through the skin, through the kidneys: causing electrolyte disturbances seen in renal and adrenal tumors, multiple myeloma, craniocerebral and pituitary tumors,... Decreased cardiac output due to mediastinal tumors, pericardial effusion, lung cancer,... Renal embolism due to lymphoma, abdominal tumor, compression of metastatic lymph nodes, renal vascular dysregulation caused by severe infection, hepatorenal syndrome or thrombosis. Acute renal failure in the kidney
Acute tubular necrosis: acute anemia due to bleeding cancer or causes as a result of long-term nephrotoxic chemotherapy, acute rhabdomyolysis due to soft tissue cancers and treatment methods high dose radiation therapy... Interstitial nephritis: chemotherapy in patients with long-term cancer treatment, infection, sarcoma, tumor lysis syndrome, deposition nephropathy in multiple myeloma, infiltration of Lymphomas, prolonged use of antibiotics,... Glomerulonephritis caused by chemotherapy: amphotericin B, cisplatin, methotrexate... Postrenal acute renal failure
Postrenal obstructions are often caused by tumors and lymph nodes that compress the excretory tract (found in kidney cancer, ovarian cancer, cervical cancer, colorectal cancer, retroperitoneal tumors, bladder cancer, prostate cancer, lymph node cancer) metastasis...). After surgery for the ureteric tumor, the wrong ureter...

Need to make differential diagnosis for cases of increased blood urea and creatinine not due to acute renal failure such as:
Hyperuremia due to: too much protein in the body, gastrointestinal bleeding, increased breakdown process, use of corticosteroids and tetracyclines... Increased blood creatinine due to: decreased secretion in the proximal tubule due to the use of cimetidine, trimethoprim, increased release from muscle. Progression in chronic renal failure. In addition, differential diagnosis between acute functional renal failure and acute renal failure. The differential diagnosis of acute renal failure from acute renal failure is posed by acute renal failure with prerenal etiology. The renal tubular function is still good, the kidney's ability to reabsorb sodium and concentrate urine is still good if acute renal failure is functionally impaired, that is, due to insufficient blood supply to ensure kidney function. When the renal tubules are physically damaged, the renal tubular function is impaired. Therefore, the test that needs to be performed is the biochemical analysis of blood and urine, which will help to identify acute renal failure, thereby distinguishing functional or structural failure.

Stop bleeding if there is bleeding: seen in cases such as gastrointestinal bleeding due to gastrointestinal cancer, hemoptysis due to respiratory cancer, vaginal bleeding due to cancer of the cervix, uterus, hematuria due to urothelial cancer,... Replace volume by mouth (oresol) or isotonic infusion with 0.9% NaCl or ringerlactate. The macromolecular fluid can be infused intravenously with Heasteril 6%. In case of acute blood loss, blood transfusion of the same blood group should be performed. Anti-shock, maintain blood pressure with vasopressor dopamine starting dose 5-10μg/kg/min and increase dose depending on blood pressure, the maximum dose used is 30μg/kg/min. Or use noradrenalin starting at 0.01 μg/kg/min if needed. Eliminate drugs that are harmful to the kidneys and drugs with potassium. Timely treatment of cancer diseases by specialized methods.

Stop taking medications that are likely to cause kidney failure. Fight infections by using broad-spectrum antibiotics and titrated according to glomerular filtration rate.
Resolving obstruction and clearing the excretory tract includes the following methods:
Percutaneous ureterostomy. Ureteral stent placement, JJ catheter. Surgery to remove the lymph nodes and tumor causing compression. In cases where surgery cannot be performed, emergency compression radiation therapy is performed with radiation doses depending on each specific case. Combination of systemic chemotherapy, monoclonal antibodies and immunotherapy depending on each specific case,... Keeping homeostasis, acid-base:
Limit water and salt. Solve hypoalbuminemia: by infusion of fresh frozen plasma, blood transfusion, amino acids,... Reduce potassium and treat hyperkalemia:
Kayexalat 30g/4-6 hours + sorbitol 30g orally. Calcichloride 0.5g slow intravenous injection from 1-2 ampoules. An infusion of 10% or 20% glucose with insulin is effective for several hours. Intravenous infusion of 1.4% sodium bicarbonate from 250-500ml if severe metabolic acidosis. Diuretic: Anuria can be converted to urine by using furosemide (lasix 20mg) 10 intravenously 1 hour apart, or by continuous intravenous infusion of 50mg/hour, with a maximum dose of 1,000mg /24 hours. If unresponsive, hemodialysis should be performed. Hemodialysis: indicated early when there are 1 or 2 of the following signs: Unresponsive to diuretics (dose as above)
Blood urea > 30mmol/l Blood creatinine >500μmol/l Blood potassium > 6mmol/l. Rapidly increasing serum potassium requires dialysis as soon as possible Increased volume burden, elevated central venous pressure, and risk of acute pulmonary edema. Metabolic acidosis blood pH < 7.2. Dietary restriction of non-protein nitrogen:
Provide energy 30-40 kcal/kg/day Prioritize glucid and lipid, protein 25g/day Supplement isotonic fluid to prevent electrolyte disturbances during urination much. Once the kidney function is stable, proceed with the treatment of the cause.
In summary, acute kidney failure due to cancer is a dangerous disease that is often in the context of serious medical disease and is caused by the malignancy itself. The disease increases the mortality rate for patients if not detected and treated promptly. Therefore, cancer patients need to have regular health check-ups to be able to detect abnormalities early and have timely treatment measures.