ADVANCES IN THE DIAGNOSIS AND THERAPY OF CAN-CER have improved patient survival. At the same time they have led to more life-threatening complications. This is related in part to the magnitude of the surgical procedures undertaken, the older age of many cancer patients and the development of more effective chemotherapeutic regimens. The ready availability of support measures, including blood products, platelet transfusions, antibiotics, effective vasopressors and total parenteral nutrition, make possible attempts at specific antitumor therapy even in seriously ill patients. Despite the magnitude of the problems encountered in patients with cancer, the recovery rate from one such complication, acute renal failure, is encouraging. A 20-year review from Memorial Sloan Kettering Cancer Center, ''2 1955-75, of dialysis in cancer patients revealed a survival of 441105 (43%) in patients with solid tumors and 11137 (31%) in patients with hematologic cancers. During the last 5 years of that study, the recovery from renal failure was 47% in patients with solid tumors and 50% in the hematologic cancer group. These results indicate that aggressive supportive care of patients with cancer can be rewarding. This study describes our experience and approach to the diagnosis and management of acute renal failure in cancer patients. Surgical procedures are detailed in a separate 9 section.
Acute renal failure (ARF) is characterized by a sudden deterioration in renal function associated with rapidly progressive azotemia. Most often oliguria (urine volume below 400 ml/24 hour) is the initial symptom, but life-threatening ARF may develop without reduction in urinary output. ~ Patients with cancer are subject to all the usual causes of renal failure as well as those primarily related to cancer and its therapy. 4, 5 A classification of oliguria into prerenal, postrenal and intrarenal causes is useful in evaluating the patient's condition clinically and in establishing protocols that will help prevent the development of ARF during therapy. 6
Prerenal azotemia is the result of inadequate renal perfusion related to hypovolemia, impaired cardiac function, marked peripheral vasodilation, particularly in septicemia, or increased renal vascular resistance. Inadequate perfusion results in a decreased glomerular filtration rate and may alter intrarenal distribution of blood flow. ~ If treated early, this type of oliguria is usually reversible. The history is of utmost importance in helping