Cancer

June 30, 2023

Advancements in cancer care have paved the way for novel therapeutics that provide improved outcomes for patients. It's incredibly important, then, to understand how these therapies impact people with cancer. For some emerging therapies, both short- and long-term complications need to be understood in an effort to care for patients from diagnosis through survivorship.

Sandra M. Herrmann, M.D., is a nephrologist at Mayo Clinic in Rochester, Minnesota. She and her colleagues are leading the way in developing an Onconephrology Clinic designed to address the unique nephrology needs of patients who have had cancer treatment. Dr. Herrmann helped publish a comprehensive update on the new field, which was published in the February 2023 issue of Kidney 360.

"More people are surviving cancer today than ever before," says Dr. Herrmann. She explains that new anti-cancer drugs such as targeted therapies, immunotherapy and other new therapeutic approaches are being used more often clinically because they have shown to improve outcomes. However, these same drugs may have "off-site" side effects that can affect organs such as the kidneys. "We need to understand how advancements in cancer treatment may impact a patient's kidneys," says Dr. Hermann.

Dr. Herrmann notes that when a patient's cancer care team works closely with experts in nephrology, side effects and kidney injury can be limited.

When to consider onconephrology

In the last five years, researchers have garnered an increased understanding of kidney-related adverse events associated with cancer treatment. Patients can begin working with a nephrologist before, during or after cancer treatment.

A collaborative onconephrology team should evaluate patients if:

• They have a high risk of developing kidney disease.
• They have existing kidney disease.
• They develop kidney disease or any kidney complication after cancer therapy.

Onconephrology can be an excellent tool for patients because the team of experts:

• Collaborates to determine the safest and most effective cancer care plan for those at high risk of kidney disease and those with existing kidney disease.
• Works alongside the cancer care team to consider how treatment plans may impact a patient's kidneys — and how those side effects can be limited.
• Provides treatment for both existing kidney conditions and those brought about by the cancer care plan.
• Monitors those at high risk of kidney disease and those with existing kidney disease for nephrology complications as they undergo cancer treatment.
• Monitors those who've undergone a kidney transplant, as they may be at a higher risk for developing cancer post-transplant.
• Creates a screening plan for patients who've had cancer treatment to detect kidney complications as early as possible so they can be treated effectively.
• Treats kidney complications that may arise following cancer treatment, and advises patients about lifestyle factors that can improve their kidney functions post-treatment.

"At Mayo Clinic, our Onconephrology Clinic is collaborative right from the start," says Dr. Herrmann. "Our multidisciplinary model of care allows us to develop safe and effective care plans quickly."

Advancements in onconephrology

Over the last two years, much research has been conducted in this emerging field. Studies and trials include topic areas such as acute kidney injury associated with anti-cancer agents, electrolyte disorders, oncohypertension, paraneoplastic glomerular diseases, kidney complications after stem cell transplantation, paraprotein-related kidney disease and transplant onconephrology.

"Today, we understand more about the kidney-related impacts of cancer treatment than we did five years ago," says Dr. Herrmann. "There is still so much more to learn as we continue both research and treatment in onconephrology."

For more information

Bonilla M., et al. Onconephrology 2022: An update. Kidney360. 2023;4;258.

Refer a patient to Mayo Clinic.