dr ayman seddik , onconephrology shield the kidney while fighting cancer final 1542015

Dr Ayman Seddik ,M.Sc , MD Ass.Prof. Nephrologist Ain Shams University Nephrology consultant

8/11/2016 Dr Ayman Seddik , onconephrology

Outline What Is Onconephrology

Scope Of Kidney Diseases In Cancer Patient

1. Aki In Cancer Patient

2. Cancer Associated Glomerulopathy

3. Chemotherapy Associated Interstetial Nephritis

4. Hypercalcemia Of Malignancy

5. Tumour Lysis Syndrome


“Onco- Nephrology”

The field of nephrology that is deals with complications of a cancer.


Oncology Nephrology

Pharmacy

ONCO

Nephrology


Potential compartments of drug induced injury

Pre Renal

Post Renal

Intrinsic Renal


Why is the Kidney Vulnerable to Chemotherapy?

Patient Specific Factors

Kidney Specific Factors

Drug Specific Factors


Watch out kidney, chemo is here!


Why is the Nephrologist called TO 7 th floor ?


Multiple Myeloma

Tubular interstitial Damage

New Glomerular paraneoplastic

disease

Kidney disease e ither pre existing or developing in the course of the

cancer

Radiation Nephropathy

Tumor lysis syndrome

Thrombotic microangiopathy

Fluid and electrolyte disorders

Obstructive Nephropath

y


1-Renal vasculature


2- Glomeruli


3- acute tubular necrosis


4- Tubulointerstitial nephritis


Cancers and electrolytes NA , K , CA , MG Hyponatremia, hypernatremia

Hypercalcemia

Hypomagnesemia

Hypokalemia and hyperkalemia

.


GLOMERULAR DISEASES WITH MALIGNANCY


Management of newly diagnosed membranous nephropathy.

Jean-François Cambier, and Pierre Ronco CJASN

2012;7:1701-1712

©2012 by American Society of Nephrology 8/11/2016 Dr Ayman Seddik , onconephrology


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TMA- TTP/HUS syndrome

Mitomycin C is associated with Hemolytic Uremic Syndrome (HUS) at total cumulative doses above 40-60 mg/m2

HUS usually occurs within 4-8 weeks after the last dose and carries a poor prognosis


Gemcitabine

Gemcitabine is a nucleoside analog with antineoplastic activity against a variety of solid tumors including pancreatic, non-small cell lung, bladder, ovarian and breast carcinomas

Mild proteinuria and microscopic hematuria may occur in up to 50% of pt treat with Gemcitabine

HUS is a well-described complication with an incidence of 0.31%-0.4%


Gemcitabine Hemolytic Uremic Syndrome

The presentation is subacute with insidious onset of renal dysfunction, hemolytic anemia, new or worsening hypertension and thrombocytopenia

Unrecognized, progression to fulminant acute renal failure and hypertensive crisis can occur

Useful Lab data: LDH, Haptoglobin, Smear Review, Reticulocyte Count, Creat, Urinalysis


Definition Potentially fatal metabolic complication that occurs in

some patients with cancer

Can result in potentially life threatening metabolic

and electrolyte abnormalities


Pathophysiology Involves a complex series of events related to the

liberation of intracellular contents from tumor cells

and inability of the kidneys to excrete and maintain

normal serum composition


Manifestations Usually occurs within 24-48 hours after initiation of

chemotherapy and may persist for 5-7 days post

therapy

May occur as early as 6 hours post chemotherapy administration


Tumor Types Non-Hodgkins lymphoma

Burkitt’s

High grade T-cell

Acute Leukemia’s Acute Promyelocytic leukemia

Acute lymphoblastic leukemia

Chronic Lymphoblastic leukemia

Solid tumors Small cell lung cancer

Breast cancer


Prevention Rasburicase- recombinant urate oxidase-

Reduces the uric acid pool

Reduces existing uric acid

Prevents the accumulation of xanthines and hypoxanthine

Does not require alkalinization

Facilitates phosphorous excretion

Dosing:

IV over 30 minutes

0.2 mg/kg IV QD or BID


Management Hydration

3 Liters daily

Aggressive hydration starting 1-2 days prior to

chemotherapy and continuing for a few days post

chemotherapy


Management Diuretics:

Furosemide

Prevents:

Fluid overload

Electrolyte imbalance

Complications of uric acid buildup


Management Dialysis: Hemodialysis/CVVH/CRRT( Requires

ICU Care)

Used for patients unresponsive to preventive measures and electrolyte corrections

Used to remove uric acid

Used in patients with: Serum potassium > 7 mEq/L

Uric acid >12 mg/dl

Phosphorous > 10 mg/dl

Symptomatic hypocalcemia

Presence of volume overload


Medication Management Avoid nephrotoxic medications

Avoid agents which block tubular reabsorption of uric acid

Aspirin

Probencid

Thiazide diuretics

Radiographic contrast containing iodine


TTT MALIGNANCY INDUCED HYPERCALCEMIA


As a Nurse?

remember that chemotherapy are potentially nephrotoxic drugs

dehydration , radiotherapy , sepsis are aditional risk factors many chemotherapeutic drugs are renally execreted bewaare of dose

reduction in those patients

tumour lysis syndrome occurs in haematologicall malignancies and tumours with high cell burden , keep your patient well hydrated , follow urine ph and uric acid level

know that ckd and esrd patients are at higher risk of cancer than general population.


Agents known to be nephrotoxic

Cisplatinum Methotrexate Gemcitabine Bisphosphanates Tyrosine Kinase Inhibitors Anti VEGF agents


Nursing Interventions Monitor weights at least daily

ECG’s

Monitor for altered level of consciousness

Strict I&O

Check pH of urine with each void, goal is to keep pH >7.0

Monitor for signs and symptoms of nausea and vomiting,

administer antiemetics WHEN NEEDED


dr ayman seddik , onconephrology shield the kidney while fighting cancer final 1542015

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