[Acute renal failure and cancer treatment]

"Acute renal failure and cancer treatment The interplay between cancer and acute kidney injury is intricate. Cancer, as much as therapies developed against it, may be responsible for acute kidney injury. Tumor lysis syndrome stems from the synergetic effects of anti-tumoral therapies in combination with the specific characteristics of the underlying tumor. Intra-tubular methotrexate precipitation is characterized by extra-renal clinical manifestations due to delayed renal drug clearance: prophylactic therapy based on optimized hydration and avoidance of nephrotoxic drugs represent the cornerstone of its management whereas rescue therapy relies on folinic acid substitution and enzyme-based therapy. Thrombotic microangiopathy is likely to result either from the cancer per se or treatments targeting the cancer. Gemcitabine stands as one the drug well acknowledged for eliciting thrombotic microngioapathy with potentially devastating consequences so that eculizumab has been contemplated as a possible therapy, on a case to case basis. Finally, it should be kept in mind that acute kidney injury in the setting of cancer represents a severe complication in the course of the disease."