Nephro-urologic emergencies in patients with cancer

Renal and urologic emergencies are common during the care of patients with cancer and generally require a multidisciplinary approach by the oncologist, emergency department physician, nephrologist, urologist, or interventional radiologist. Acute kidney injury is a frequent complication of cancer treatment that entails a higher 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 % require dialysis on initial presentation. Renal function in these patients may rapidly improve with treatment of the myeloma by the oncologist. Patients with cancer may present to the emergency department with severe derangements in electrolyte levels and may require immediate treatment by the emergency department physician to prevent cardiac arrhythmias or renal failure. Hematuria may have a subtle presentation with only microscopic hematuria noted on urinalysis exam, while patients with severe hematuria may develop hemorrhagic shock. Obstructive uropathy may occur anywhere along the urinary tract and generally requires intervention by the urologist or radiologist to decompress the collecting system.