Over the past few decades, there has been rapid advancement in the care of cancer patients with a steady flow of novel therapeutics introduced into clinical practice. Accompanying the new therapies are myriad unintended treatment-related effects, some of which have involved the kidneys, electrolytes, acid-base balance, and blood pressure control. There has also been a shift in the mindset of the treating physicians (oncologists and nephrologists) to attempt a pathophysiological understanding and nuanced management of such treatment-related effects rather than binary labeling of drugs into “nephrotoxic” and “non-nephrotoxic” and discontinuation of therapy thought to be nephrotoxic. This evolution in thinking
In the past decades, the field of hematology-oncology has greatly evolved, bringing to practice the routine use of novel therapies with various mechanisms of action, including chemotherapeutic, immunotherapeutic, and targeted agents, which are often combined into complex regimens (Figure 1).
Examples of cancer-directed therapies
With these ongoing advances, unique drug-drug interactions, treatment timing, dosing challenges, as well as toxicity profiles have emerged, requiring more advanced expertise from our subspecialty consultants who co-manage these patients. My practice focuses on patients with hematologic malignancies, with a particular interest in plasma cell dyscrasias. These encompass a large spectrum of
Fresenius Medical Care announced in March that it was forming a separate company as part of a three-way merger with InterWell Health and Cricket Health. Through the merger, the largest dialysis provider in the United States will combine with two value-based care companies: a physician organization of more than 1600 nephrologists and a technology start-up. The start-up, Cricket Health, created a patient platform, care-support program, and machine-learning program aimed at identifying kidney disease and predicting disease progression.
“We see value-based care as the future of health care, and this new company will make a dramatic difference for thousands of people,”
Earlier this year, ASN received requests from the American Board of Internal Medicine (ABIM) and Accreditation Council for Graduate Medical Education (ACGME) that taken separately would impact the future training of nephrologists. After careful consideration and thought, the ASN Council responded with a request for 8 months to convene the community and reconsider all aspects of the future of the specialty of nephrology.
“This is a unique opportunity to respond to the requests of ABIM and ACGME. Nephrology has evolved over the last 5 to 10 years as more options to treat patients earlier have become available,” said former ASN
Kidney injury and kidney failure are frequently found in patients with multiple myeloma. With the introduction of novel agents in the last two decades, the outcome of patients with multiple myeloma has tremendously improved. The median survival has reached 7.7 years for patients under the age of 65 years (1). Despite the advances in therapies, patients continue to develop end stage kidney disease (ESKD). The survival of myeloma patients on dialysis is inferior to those without myeloma. Because of poor prognosis of multiple myeloma, kidney transplantation has not been considered an option (2). However, with evolving
Monoclonal gammopathy of unknown significance (MGUS), commonly considered a benign condition, is characterized by a low level of detectable monoclonal immunoglobulin (Ig) in the serum (<30 g/L) and <10% monoclonal plasma cells on bone marrow biopsy. Assuming these low levels of circulating Igs do not cause any end organ damage, treatment is usually not recommended for MGUS. However, in some patients with MGUS, these low levels of Ig or kappa/lambda light chains can cause direct kidney deposition or activation of complements leading to kidney diseases. Because of this, in 2012, the term “monoclonal gammopathy of renal significance” (MGRS) was coined
Diabetic nephropathy is the leading cause of chronic kidney disease (CKD) in the United States and one of the most common complications of diabetes mellitus, increasing the risk of cardiovascular disease in individuals with diabetes. Risk factors for developing diabetes-related kidney disease include poor glycemic control, hypertension, older age, dyslipidemia, and genetic factors, among others (1). Jia Xin Huang, MD, et al. (2) recently published an article about the role of acute kidney injury (AKI) and diabetic ketoacidosis (DKA) in the development of proteinuria in children with diabetes.
The study is a well-designed retrospective chart review
Traditionally, the field of hematology-oncology has elicited a feeling of despair and morbidity in many until a few years ago. However, with the growing advances in the field of oncology, there are a larger number of patients who are being diagnosed with cancers and an even larger number surviving cancer. With this change in the field of oncology, we—as nephrologists—encounter many patients who develop kidney diseases due to cancer or the therapy used for the treatment of cancer.
From electrolyte and acid-base imbalance to acute and chronic kidney disease, including glomerular diseases, nephrologists are seeing a growing number of patients
Committed to creating a world without kidney diseases, the American Society of Nephrology (ASN)—together with other members of the kidney community—has produced incredible results in federal legislative and regulatory policy during the past decade, such as the landmark Executive Order on Advancing American Kidney Health. At a national level, patient advocates, health professionals, and policymakers are rallying around the four priorities of ASN's We’re United 4 Kidney Health campaign: intervene earlier, transform transplant, accelerate innovation, and achieve equity.
Due to greater disinformation, polarization, and blowtorch politics, one in five people in the United States believes “The government, media, and financial
Pamidronate has been found to be associated with CG in patients with multiple myeloma and breast cancer. In these patients, pamidronate is used in higher doses to prevent skeletal complications. It is hypothesized that pamidronate affects the glomerular epithelial cells (1).
Light microscopy: Jones silver stain, proliferation of visceral epithelial cells and collapse of glomerulus known as collapsing focal segmental glomerulosclerosis (FSGS). Image credit: K.S. Vinay.