Over the past 10 to 20 years, there has been a revolution in the care of patients with cancer. In addition to classic chemotherapy agents, anti-cancer agents now include targeted therapies and immunotherapies, which harness the power of the immune system. These new therapies have transformed cancer into a chronic disease for many patients. Importantly, acute and chronic kidney diseases, electrolyte and acid-base disorders, and hypertension have become highly prevalent complications in this group of patients. This is particularly true for those with liver cancer, multiple myeloma, renal cell carcinoma, leukemias and lymphomas, and cancer patients treated with potentially nephrotoxic
In oncology, survivorship focuses on the health and well-being of a person with cancer from the time of diagnosis until the end of life (1). Hypertension is a growing global public health problem and a contributor to cardiovascular disease (CVD) (2). The relationship among hypertension, cancer, chronic kidney disease (CKD), and CVD is multifaceted, sharing common risk factors, such as smoking, obesity, and metabolic syndrome. For the same reasons, oncohypertension is an emerging subspecialty focusing on the close interplay between hypertension and cancer (3, 4). Hypertension in patients with cancer can be
The field of onconephrology has recently begun to take shape, and thus, education aimed at onconephrology is still evolving. Importantly, onconephrology was galvanized in the age of social media; thus, non-traditional media is playing a pivotal role in shaping education in onconephrology. For example, the American Society of Onconephrology (ASON) was largely materialized by a group of nephrologists all over the world using WhatsApp to discuss and share cases and forge research collaborations.
The first textbook devoted solely to onconephrology topics was published in 2005 (1) and subsequently, two additional in 2015 (2) and 2019 (
Latin America is a vast region of primarily middle- and low-income countries with approximately 660 million people who share a Latin extraction and language (Spanish or Portuguese). The area exhibits extreme diversity in socioeconomic status and access to quality health care. The prevalence of chronic kidney disease (CKD) seems to be growing in Latin America (1). Population aging, suboptimal treatment of comorbidities such as hypertension, and the growing epidemic of type 2 diabetes affect many people in this region. In addition, Latin Americans often live in poverty and follow unhealthy diets, lack physical exercise, and have precarious working
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
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
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
A llogeneic stem cell transplant (SCT) is used to cure several hematological disorders. The incidence of both acute kidney injury and chronic kidney disease (CKD) post-SCT remains high. A rare cause of CKD post-allogeneic SCT is development of glomerular disease, which by many is considered to be a manifestation of chronic graft-versus-host disease (GVHD) affecting the kidney (1). Based on mouse models, it has been proposed that GVHD could be a direct T cell-mediated injury or that the chronic systemic inflammatory state of GVHD leads to autoimmune induction and glomerulopathy (2). The incidence of nephrotic syndrome