UMEM Educational Pearls

Category: Critical Care

Title: Cancer and Acute Kidney Injury (AKI)

Keywords: AKI, critical care, ICU, cancer, renal failure, acute kidney injury (PubMed Search)

Posted: 6/21/2011 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Cancer patients admitted to ICUs with AKI or who develop AKI during their ICU stay have increased risk of morbidity and mortality. AKI in cancer patients is typically multi-factorial:

Causes indirectly related to malignancy

  • Septic, cardiogenic, or hypovolemic shock (most common)

  • Nephrotoxins:

    • Aminoglycosides

    • Contrast-induced nephropathy

    • Chemotherapy 

  • Hemolytic-Uremic Syndrome

Causes directly related to malignancy

  • Tumor-lysis syndrome

  • Disseminated Intravascular Coagulation

  • Obstruction of urinary tract by malignancy

  • Multiple Myeloma of the kidney

  • Hypercalcemia

Because AKI increases the already elevated morbidity and mortality in these patients, prevention (e.g., using low-osmolar IV contrast, avoiding nephrotoxins), early identification (e.g., strict attention to urine output and renal function), and aggressive treatment (e.g., early initiation of renal replacement therapy) is essential.


Benoit D. Acute kidney injury in critically ill patients with cancer. Critical Care Clinics 2010 Jan; 26(1): 151-79

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