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癌症患者的急性肾损伤
Acute Kidney Injury in Patients with Cancer


Mitchell H. Rosner ... 肿瘤 • 2017.05.04

恶性肿瘤并发急性肾损伤的不同病因的诊断及治疗

 

谭颖,赵明辉*

北京大学第一医院肾内科

*通讯作者

 

恶性肿瘤患者常并发急性肾损伤(AKI),发生率及严重程度因恶性肿瘤分期、治疗方案及合并症不同而各异。本期《新英格兰医学杂志》发表的题为《癌症患者的急性肾损伤》的综述介绍了癌症患者发生AKI的众多危险因素及不良预后。根据近年来国际上的研究进展,该综述对临床常见的血液系统肿瘤、肾细胞癌、溶瘤综合征、高钙血症、造血干细胞移植、化疗导致的AKI的发生率、临床表现、发病机制、诊断及治疗手段进行了全面介绍1。这些论述和观点,有助于全面评估肿瘤患者罹患AKI的可能病因,选择和制订合理的预防及治疗方案,以改善合并AKI的癌症患者的长期预后。

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癌症患者中常见急性肾损伤1,2;其发病率和严重程度不同,取决于癌症类型和分期、治疗方案以及共患病况3。在丹麦一项针对37,267例新发癌症病例的为期7年的研究中,依照风险、损伤、衰竭、肾功能丧失和终末期肾脏疾病(RIFLE)分级法(表1)定义的急性肾损伤的1年期风险为17.5%4。风险、损伤和衰竭三个分级的5年期风险分别为27.0%、14.6%和7.6%。此外,发生急性肾损伤的患者中,有5.1%在1年内进展为需要长期透析4

 

表1. 急性肾损伤的RIFLE分级(风险、损伤、衰竭、肾功能丧失和终末期肾病)*

* Cr代表血清肌酐,GFR代表肾小球滤过率。


危重癌症患者发生急性肾损伤的风险最高(发病率,54%)5,特别是患血液系统癌症或者多发性骨髓瘤的患者,以及发生感染性休克的患者6。本篇综述了癌症患者中的急性肾损伤。





作者信息

Mitchell H. Rosner, M.D., and Mark A. Perazella, M.D.
From the Division of Nephrology, University of Virginia Health System, Charlottesville (M.H.R.); and the Section of Nephrology, Yale University School of Medicine, New Haven, and the Veterans Affairs Medical Center, West Haven — both in Connecticut (M.A.P.). Address reprint requests to Dr. Rosner at the Division of Nephrology, University of Virginia Health System, Box 800133, Charlottesville, VA 22908, or at mhr9r@virginia.edu.

 

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