Nephro-Urologic Emergencies in Patients with Cancer

Abstract

Renal and urologic emergencies are common in patients with cancer and generally require a multidisciplinary approach by the oncologist, emergency room physician, nephrologist, urologist, and interventional radiologist. Acute kidney injury is a frequent complication of cancer treatment that has a high mortality rate. Nephrologists are frequently needed to provide supportive dialysis until renal function recovers. More than one half of patients with multiple myeloma present with renal injury, and 10 % of them need dialysis upon initial presentation. Renal function in these patients may rapidly improve with treatment of the myeloma. Patients with cancer may present to the emergency room with severe derangements in electrolyte levels and may need immediate treatment by the emergency room physician to prevent cardiac arrhythmias or renal failure. Hematuria may have a subtle presentation, with only microscopic hematuria noted upon urinalysis examination, whereas patients with severe hematuria may experience hemorrhagic shock. Obstructive uropathy may occur anywhere along the urinary tract and generally requires intervention by a urologist or radiologist to decompress the collecting system.