Cancer and Kidney Diseases Onconephrology Comes of Age

  • 1 Mark A. Perazella, MD, is with the Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT. Mitchell H. Rosner, MD, is with the Division of Nephrology, Department of Medicine, University of Virginia Health, Charlottesville. Both authors are founding members of the American Society of Onconephrology.
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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

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 therapies. Many patients who now survive cancer are left with the sequelae of chronic kidney disease. These various intersections of cancer and the kidney have led to the recognition that the fields of nephrology and oncology are intricately linked and that a focus on kidney diseases is needed to improve outcomes and maximize the benefits of these revolutionary therapies. In response to this rapidly growing need, the new subfield of onconephrology was born.

This rapidly growing subspecialty has become an important source of nephrology consultations, as oncology patients now constitute a significant number of patients who nephrologists examine for kidney-related conditions within inpatient hospital floors, medical intensive care units, and outpatient clinics. The growth in the number of patients with onconephrology disorders is a result of two major factors. First, there is an increasing number of patients with cancer, and second, there has been a steady reduction in cancer death rates because of more effective cancer therapies, such as the traditional chemotherapeutic agents, targeted cancer therapies, cancer immunotherapies, and stem cell therapies.

It is notable that onconephrology extends beyond nephrologists and oncologists. Care for oncology patients with kidney diseases has become more specialized and complicated, requiring collaboration among nephrologists, hematologists, oncologists, intensivists, pharmacists, urologists, pathologists, and palliative care specialists. It is illustrative that many of the largest cancer centers in the United States have developed multi-disciplinary clinics that bring together these various specialties to address kidney-related conditions in patients with cancer.

What had been a small group of interested nephrologists (participating in the ASN Onconephrology Forum) has grown into a large number of nephrologists (and other specialists) with expertise in onconephrology. Experts have designed and participated in Onconephrology Symposia at ASN Early Programs and onconephrology conferences at several medical centers specializing in cancer care. Journals focused on onconephrology have emerged (e.g., Journal of Onco-Nephrology and Frontiers in Nephrology: Onconephrology) and provide a forum for original research, invited reviews, case reports, symposia highlights, debates, and clinical onconephrology images. In fact, most nephrology journals have sections dedicated to onconephrology.

One of the most exciting endeavors in this area is the creation of the American Society of Onconephrology (ASON) by a group of founding members. This new society aims to promote onconephrology research, education, and scholarship for veteran nephrologists, newly minted nephrologists, various trainees (fellows, residents, and students), and other interested health care providers. The goal is to grow a multi-specialty membership, feature monthly educational conferences, hold yearly symposia, and ultimately (and most importantly) improve the care of patients with cancer and kidney diseases. Although such sub-specialization in onconephrology has been a welcome development to improve patient care, it will be incumbent on all nephrology providers to be acquainted with the intersection of the kidney and cancer.

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