Dr ayman seddik , onconephrology shield the kidney while fighting cancer final 1542015
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Transcript of 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
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
8/11/2016 Dr Ayman Seddik , onconephrology
“Onco- Nephrology”
The field of nephrology that is deals with complications of a cancer.
8/11/2016 Dr Ayman Seddik , onconephrology
Oncology Nephrology
Pharmacy
ONCO
Nephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
Potential compartments of drug induced injury
Pre Renal
Post Renal
Intrinsic Renal
8/11/2016 Dr Ayman Seddik , onconephrology
Why is the Kidney Vulnerable to Chemotherapy?
Patient Specific Factors
Kidney Specific Factors
Drug Specific Factors
8/11/2016 Dr Ayman Seddik , onconephrology
Watch out kidney, chemo is here!
8/11/2016 Dr Ayman Seddik , onconephrology
Why is the Nephrologist called TO 7 th floor ?
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
1-Renal vasculature
8/11/2016 Dr Ayman Seddik , onconephrology
2- Glomeruli
8/11/2016 Dr Ayman Seddik , onconephrology
3- acute tubular necrosis
8/11/2016 Dr Ayman Seddik , onconephrology
4- Tubulointerstitial nephritis
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
Cancers and electrolytes NA , K , CA , MG Hyponatremia, hypernatremia
Hypercalcemia
Hypomagnesemia
Hypokalemia and hyperkalemia
.
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
GLOMERULAR DISEASES WITH MALIGNANCY
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
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%
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
Definition Potentially fatal metabolic complication that occurs in
some patients with cancer
Can result in potentially life threatening metabolic
and electrolyte abnormalities
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
Management Hydration
3 Liters daily
Aggressive hydration starting 1-2 days prior to
chemotherapy and continuing for a few days post
chemotherapy
8/11/2016 Dr Ayman Seddik , onconephrology
Management Diuretics:
Furosemide
Prevents:
Fluid overload
Electrolyte imbalance
Complications of uric acid buildup
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
Medication Management Avoid nephrotoxic medications
Avoid agents which block tubular reabsorption of uric acid
Aspirin
Probencid
Thiazide diuretics
Radiographic contrast containing iodine
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
TTT MALIGNANCY INDUCED HYPERCALCEMIA
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology
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.
8/11/2016 Dr Ayman Seddik , onconephrology
Agents known to be nephrotoxic
Cisplatinum Methotrexate Gemcitabine Bisphosphanates Tyrosine Kinase Inhibitors Anti VEGF agents
8/11/2016 Dr Ayman Seddik , onconephrology
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
8/11/2016 Dr Ayman Seddik , onconephrology
8/11/2016 Dr Ayman Seddik , onconephrology