Onconephrology

Onconephrology (from the Ancient Greek onkos (ὄγκος) meaning bulk, mass, or tumor, nephros (νεφρός) meaning kidney, and the suffix -logy (-λογία), meaning "study of") is a burgeoning new specialty in nephrology that deals with the study of kidney diseases in cancer patients.

A nephrologist who takes care of patients with cancer is called an Onconephrologist. This branch of nephrology encompasses both the hematologic and oncology based cancers and their treatment related complications that deal with the kidney. Unlike general nephrology, there are several aspects of onconephrology that are unique. Kidney failure from break down of cancer cells, usually after chemotherapy, is unique to onconephrology.[1] The Syndrome of Inappropriate Anti Diuretic Hormone (SIADH) that causes low serum sodium concentration and first described in lung cancer patients is common in cancer patients. Kidney diseases that are unique to bone marrow transplant (aka Stem Cell Transplant or SCT) are frequently seen in cancer patients. Fluid, electrolytes and acid base disturbances are much more common and often severe in cancer patients, especially in those who receive chemotherapy. Several chemotherapeutic agents – for example cisplatin – are associated with acute and chronic kidney injuries. Newer agents such as anti Vascular Endothelial Growth Factor (anti VEGF) are also associated with similar injuries, as well as proteinuria, hypertension and thrombotic microangiopathy.[2]

The most common form of kidney disease in cancer patients is acute kidney injury (AKI) which can usually be due to volume depletion from vomiting and diarrhea that occur following chemotherapy or occasionally due to kidney toxicities of chemotherapeutic agents. Less frequently AKI can occur due to obstruction to urine flow from tumor or lymph node enlargement. Also, cancer cells by infiltrating the kidney or myeloma proteins by precipitating with in the tubules of the kidney can cause kidney injury.[3]

Cancer management has become comprehensive and multidisciplinary, and often an onconephrologist is included in major centers to address and advice on kidney problems in cancer patients.

Topics that are usually of interest to onco-nephrologists are: 1. Electrolyte disorders of malignancy 2. Secondary Glomerular diseases of malignancy 3. Cancer related renal complications 4. Chemotherapy related renal complications 5. Myeloma Nephrology 6. Amyloidosis Nephrology 7. Thrombotic Microangiopathy and all its causes and treatment strategies( HUS/TTP) 8. Bone marrow transplant related kidney diseases 9. Radiation Nephropathy 10. Tumor Lysis Syndrome 11. Acute Kidney injury in the hospitalized cancer patient. 12. The ethics of dialysis in the dying cancer patient 13. Dialysis and chemotherapy agents 14. Tumor invasion of the kidney 15. Obstructive renal disease 16. Chronic Kidney disease after chemotherapy induced AKI 17. Renal cell cancer 18. CKD following nephrectomy 19. Targeted therapy and immunotherapy associated kidney toxicities

Centers in the United States and other countries have started forming onconephrology-related patient approach.

Several textbooks have been written on this topic. Onconephrology: cancer, chemotherapy and the kidney by Jhaveri and Salahudeen by Springer and Cancer and the Kidney by Cohen by Oxford Univ Press

In addition, the American Society of Nephrology formed the first ever Onconephrology Forum (ONF) under the leadership of Salahudeen and Bonventre focusing on onconephrology at national levels.[4]

There is a journal dedicated to this field called the Journal of Onconephrology(JON)

References
  1. Salahudeen, A. K.; Bonventre, J. V. (2012). "Onconephrology: The Latest Frontier in the War against Kidney Disease". Journal of the American Society of Nephrology. 24 (1): 26–30. doi:10.1681/ASN.2012070690. PMID 23138480.
  2. Robinson, Emily S.; Khankin, Eliyahu V.; Karumanchi, S. Ananth; Humphreys, Benjamin D. (2010). "Hypertension Induced by Vascular Endothelial Growth Factor Signaling Pathway Inhibition: Mechanisms and Potential Use as a Biomarker". Seminars in Nephrology. 30 (6): 591–601. doi:10.1016/j.semnephrol.2010.09.007. PMC 3058726. PMID 21146124.
  3. Lahoti, A; Nates, JL; Wakefield, CD; Price, KJ; Salahudeen, AK (2011). "Costs and outcomes of acute kidney injury in critically ill patients with cancer". The Journal of Supportive Oncology. 9 (4): 149–55. doi:10.1016/j.suponc.2011.03.008. PMID 21809520.
  4. Salahudeen, A. K.; Bonventre, J. V. (2012). "Onconephrology: The Latest Frontier in the War against Kidney Disease". Journal of the American Society of Nephrology. 24 (1): 26–30. doi:10.1681/ASN.2012070690. PMID 23138480.
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