Onconephrology 2022: An Update

Abstract

Onconephrology is an upcoming and expanding subspecialty that deals with the intersections between hematology/oncology and nephrology. With the paradigm shift in the understanding of cancer immunobiology and mechanisms of oncotherapeutic drug toxicities, it is important for a nephrologist to have a sound understanding of this field. Over the last 5 years, there have been immense developments in our understanding of kidney-related adverse events from various targeted, immuno- and cellular-based therapies. Pathogenic mechanisms of electrolyte imbalance, hypertension (oncohypertension), and AKI from multiple forms of cancer therapies have been explored. Significant research has also been conducted in the field of transplant onconephrology. In this review, we have tried to assimilate the most recent updates in the last 2 years in this ever-growing and fascinating field.

Trial registration: ClinicalTrials.gov NCT03816332 NCT04339062.

Figure 1

Mechanism of action of the different VEGF signaling pathway inhibitors agents and the pathophysiologic changes leading to hypertension and proteinuria. ECF, extracellular fluid; eNOS, endothelial nitric oxide synthase; Mab, monoclonal antibody; NO, nitric oxide; PlGF, placental growth factor; ROS, reactive oxygen species; SVR, systemic vascular resistance; TKI, tyrosine kinase inhibitor; VEGF, vascular endothelial growth factor; VEGFR, vascular endothelial growth factor receptor.

Figure 2

A concept map of clinical and pathological clues to differentiate primary versus malignancy-associated membranous nephropathy. EM, electron microscopy; GBM, glomerular basement membrane; IF, immunofluorescence; LM, light microscopy; MN, membranous nephropathy; NELL-1, neural epidermal growth factor–like 1 protein; PCDH7, protocadherin 7; PLA2R, phospholipase A2 receptor; SEMA 3B, semaphorin-3B; THSD7A, thrombospondin type I domain–containing 7A.

Figure 3

The glomerular diseases seen with immune checkpoint inhibitors. CTLA-4, cytotoxic T lymphocyte–associated protein-4; DC, dendritic cell; MCD, minimal change disease; PD-1, programmed cell death protein-1; PD-L1, programmed cell death protein–associated ligand-1; TCR, T cell receptor.

Figure 4

A flowchart of the spectrum of renal diseases in monoclonal gammopathies, divided into paraprotein-related and treatment-related renal diseases. AH, amyloid heavy chain; AHL, amyloid light and heavy chain; AIN, acute interstitial nephritis; AL, amyloid light chain; ATI, acute tubular injury; BRAFi, v-raf murine sarcoma viral oncogene homolog B1 inhibitor; C3, complement 3; HCDD, heavy chain deposition disease; ICPi, immune checkpoint inhibitor; IgG 1&4, immunoglobulin G type 1&4; IgM, immunoglobulin M; LCDD, light chain deposition disease; LHCDD, light-heavy chain deposition disease; MIDD, monoclonal immunoglobulin deposition disease; mTORi, mammalian target of rapamycin inhibitor; PGMIDD, proliferative N with monoclonal IgG deposits; TMA, thrombotic microangiopathy; TLS, tumor lysis syndrome.