Figure 52

Causes of prerenal failure (ARF). Prerenal ARF is encountered frequently in the cancer patient, particularly in association with depletion of the extracellular fluid (ECF) volume, which is caused by excessive loss from the gastrointestinal tract due to vomiting or diarrhea induced by cancer or its therapy. Also, hypov-olemia may occur owing to internal fluid loss due to translocation of ECF volume with sequestration in third spaces, as seen in peritonitis, bowel obstruction, malignant effusion, or interleukin-2 therapy [8].

A decrease in effective intravascular volume may occur owing to peripheral vasodilation, as frequently noted in sepsis. A decrease in cardiac output due to cardiac tamponade secondary to malignant pericardial disease also may produce prerenal ARF. Hepatobiliary disease may cause alterations in intrarenal hemo-dynamics with resultant hepatorenal syndrome, as seen in hepatic veno-occlusive disease following bone marrow transplantation (see Fig. 5-3). The administration of nons-teroidal anti-inflammatory agents for analgesia in the cancer patient may lead to ARF by elimination of the prostaglandin-mediated intrarenal vasodilatation. This homeostatic mechanism represents a critical hemodynamic adjustment necessary for maintaining glomerular filtration rate in a patient with cancer in whom renal blood flow may be decreased owing to a variety of causes.

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