Insuffisance rénale aiguë chez le patient d'onco-hématologie admis en réanimation

Abstract

Acute kidney injury (AKI) is common in oncohematology patients and can be a sign of the underlying neoplasm. The incidence of AKI in cancer patients is around 10% and exceeds 50% when admitted to intensive care. The tumor pathologies most at risk of AKI are myeloma, urinary tract cancers and acute leukemias. The main etiologies of AKI in this population include hypovolemia, sepsis, tumor lysis syndrome (TLS), myeloma cast nephropathy, urinary tract obstruction, tumor infiltration of the renal parenchyma and hypercalcemia. TLS, secondary to the massive release of intracellular tumor content, is a hematological emergency and requires close monitoring. Myeloma cast nephropathy requires rapid therapeutic management in order to optimize the chances of renal recovery. AKI complicates the management of oncohematology patients by contraindicating or modifying the pharmacokinetics of treatments, reducing the likelihood of achieving remission of the neoplasm. The management of these patients requires close collaboration between intensivists and hematologists or oncologists to define the treatment plan, prevent serious complications and ensure optimal follow-up.