This should be of great interest to oncologists, oncological haematologists and nephrologists.
This interesting virtual conclave on onconephrology organised by the nephrology department at the Sir Ganga Ram Hospital at New Delhi on the 19-20th December.
What is onconephrology?
Onconephrology is a burgeoning new specialty in nephrology that deals with the study of kidney diseases in cancer patients. Although the commonest forms of kidney disease in cancer patients are acute kidney injury AKI due to fluid depletion, sepsis and drugs and urinary tract obstruction due to the tumour, there are many kidney diseases that are infrequently or never seen outside onconephrology.
For a start, tumour lysis syndrome, radiation therapy, bone marrow transplant related kidney diseases are unique to the field. Electrolyte abnormalities can occur through several mechanisms including SiADH and toxicities of various chemotherapy agents. These damage the kidney through tubular injury and more rarely thrombotic microangiopathy. The newer targeted therapy and immunotherapy agents do not always spare the kidney.
Direct tumour invasion of the kidney or primary renal tumours and nephrectomy leading to CKD are other considerations. Sometimes, a distant tumour can lead to glomerular disease. Myeloma and related plasma cell Disorders can cause acute and chronic kidney disease in a variety of ways including hyperkalaemia, cast nephropathy, amyloidosis and fibrillary glomerulonephritis.
Dialysis in cancer patients has particular considerations from the pharmacokinetics and removal of chemotherapy agents to the ethics of renal replacement. Finally, there is the increased risk of cancer in patients with CKD especially after on dialysis and transplantation.