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Can J Kidney Well being Dis. 2020 Oct 15;7:2054358120962589. doi: 10.1177/2054358120962589. eCollection 2020.
INTRODUCTION AND OBJECTIVE: Onconephrology is a brand new and evolving subject that offers with kidney issues in sufferers with most cancers in addition to the administration of most cancers in sufferers with preexisting kidney illness. With growing numbers of sufferers with most cancers with kidney-related issues, the sphere has garnered elevated consideration. Thus, an annual Larger Toronto Space Onconephrology Curiosity Group symposium was held in Might 2019. The target of the assembly was to show the junctures between oncology and nephrology by highlighting current knowledge concerning (1) kidney impairment in stable organ malignancies, (2) administration and therapy of kidney most cancers, (3) kidney impairment in hematologic malignancies, (4) malignancy and kidney transplantation, and (5) hyponatremia in sufferers with most cancers.
METHODS AND SOURCES OF INFORMATION: By way of a structured presentation, the group explored key matters mentioned at a Kidney Illness Bettering International Outcomes (KDIGO) Controversies Convention on Onconephrology. Knowledgeable opinions, medical trial findings, and publication summaries had been used as an instance affected person and treatment-related issues in onconephrology.
KEY FINDINGS: Kidney issues in sufferers with most cancers are a central theme in onconephrology. An estimated 12% to 25% of sufferers with stable organ malignancies have continual kidney illness (CKD), though in sure cancers, the prevalence of CKD is greater. Kidney impairment can also be a standard complication of some hematologic malignancies. The incidence of renal failure in sufferers with a number of myeloma is estimated at 18% to 56% and lightweight chain forged nephropathy is seen in roughly 30% of those sufferers. As well as, there seems to be a bidirectional relationship between kidney most cancers and CKD, with some knowledge units suggesting the danger will increase as kidney operate declines. Most cancers can also be of concern in sufferers with preexisting kidney illness. Kidney transplant recipients have a higher threat of most cancers and the next threat of cancer-related mortality. Kidney issues have additionally been related to novel most cancers therapies, comparable to immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cell remedy. An estimated 2% to 4% of sufferers initiating an immune checkpoint inhibitor might develop nephrotoxicity, whereas as much as 40% of sufferers on CAR T-cell remedy expertise cytokine launch syndrome (CRS). Tumor lysis syndrome and electrolyte abnormalities, comparable to hyponatremia, have additionally been reported with CAR T-cell remedy. Whereas the incidence and prevalence of hyponatremia differ relying on the most cancers sort and serum sodium cutoff level, hyponatremia could also be seen in as much as 46% of sufferers hospitalized in most cancers facilities.
CONCLUSIONS: Onconephrology is a creating subject and the themes arising from this assembly point out a necessity for higher collaboration between oncologists and nephrologists. Academic symposia and onconephrology fellowship packages might enable for improved most cancers look after sufferers with kidney illness.
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