The past decade has seen a revolution in the treatment of patients with cancer with novel therapies that harness the power of the immune system to kill tumor cells (1). This has been achieved by removing checkpoints on the immune system that typically are exploited by tumor cells that allow for proliferation and growth. Two classes of immune checkpoint inhibitors are available: drugs that act against checkpoint proteins programmed death 1 (PD-1) or cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) or both (2). An expected side effect of these drugs is the occurrence of immune-related adverse events (irAEs)
We cringe when we hear about how many relative value units (RVUs) we have produced. There is no doubt that being a clinician is defined by much more than our RVUs. Nephrologists care for the most complex patients, and many elements of this care are not easily captured by the RVU system (1, 2). It is no wonder that RVUs have become a “four-letter word” for clinicians.
Relative value scales date back to the 1950s and were designed to establish prices that state and federal governments would pay for physician services on the basis of relative
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