Onco-nephrology: an appraisal of the cancer and chronic kidney disease links

Abstract

A bidirectional relationship has been observed for kidney disease and cancer. On the one hand, cancer is an important complication noted in kidney disease as well as a major cause of morbidity and mortality in this group. On the other hand, improved cancer treatment has prolonged survival, but also increased the development of acute and chronic kidney disease. The combination of cancer and kidney disease makes it challenging for clinicians to provide comprehensive and safe therapies for this group of patients. As such, clinicians caring for this group must develop expertise and become competent in the practice of a newly evolving subspecialty of nephrology known as 'onco-nephrology'. This brief narrative review will focus on the cancer risk in patients with underlying kidney disease, the therapies such as erythropoiesis-stimulating agents on cancer progression and other outcomes, and the appropriate dosing of anti-cancer agents in patients with underlying kidney disease.

Keywords: albuminuria; cancer; dosage adjustment; erythropoiesis-stimulating agents; kidney disease.

FIGURE 1:

Bidirectional relationship between kidney disease and cancer. SIADH, syndrome of inappropriate antidiuretic hormone secretion; AKI/CKD, acute kidney injury/chronic kidney disease; MN, membranous nephropathy; MCN, minimal change nephropathy; TMA, thrombotic microangiopathy; TIN, tubulointerstitial nephritis; NDI, nephrogenic diabetes insipidus; MRI, magnetic resonance imaging with gadolinium.