Renal infections in cancer patients

Renal infections are common in cancer patients and are associated with significant morbidity, mortality and healthcare costs. Because of compromised immune systems and concomitant cancer therapy, including systemic chemotherapy, radiation therapy, and surgical intervention, renal infections are often severe and lead to complications in cancer patients. Mechanisms of immune dysfunction in cancer, including possible causes of infection are discussed. The presentation and management of various bacterial, fungal, mycobacterial, viral, and parasitic renal infections in cancer patients is reviewed. Bacterial infections in cancer patients are challenging to manage because of high rates of antimicrobial resistance, tumor-induced mechanical obstruction, and indwelling surgical devices. Mycobacterial infections occur because of the use of Bacillus Calmette-Guérin (BCG) in bladder cancer treatment or reactivation of tuberculosis. Fungal infections caused by candida and other molds are challenging, particularly in patient with catheters, and require aggressive diagnostic workup and management. Viral reactivation occurs in cancer patients because of immune suppression and is common in patients undergoing solid organ or hematopoietic stem cell transplants. Hepatitis viruses have severe renal manifestations. The management of infections in cancer patients tends to be challenging; guidelines related to antibiotic prophylaxis and suppressive regimens are unclear. A high index of suspicion is required, and aggressive or preemptive management may be needed for fungal or viral infections.