Abstract
Cancer patients have an incidence of about 60% kidney disease development and are at elevated risk of acute renal damage. Kidney disease in these patients is frequently associated with nephrotoxicity from the ongoing oncological treatment. New anticancer therapeutic strategies, such as targeted therapies and immunotherapies, offer substantial benefits in the treatment of many neoplasms. However, their use is associated with significant nephrotoxicity, which qualitatively differs from that seen with traditional cytotoxic chemotherapy, while the underlying mechanisms are complex and still to be clearly defined. Nephrologists need to be knowledgeable about the array of such renal toxicities for effective collaboration with the oncologist in the prevention and management of kidney involvement. Renal adverse effects may range from asymptomatic proteinuria to renal failure, and their prompt identification and timely treatment is essential for optimal and safe care of the patient. In this article, after presenting clinical cases we discuss the differing renal toxicity of three novel anticancer agents (aflibercept, dasatinib, and nivolumab) and possible measures to counter it.
Highlights
Onco-nephrology is today an established, evolving subspecialty that encompasses the complex relationship between cancer and the kidneys
We report here three cases which display multiple different aspects of the nephrologist’s involvement in differential renal toxicities from three commonly used new anticancer agents, and discuss them in the context of the most recent literature, focusing on treatment and on the prevention/minimization of renal damage
Renal adverse effects including hypertension, proteinuria, and the worsening of renal function associated with novel targeted therapies and immunotherapies are increasingly recognized in clinical practice, but strategies to mitigate them have not been firmly established [5]
Summary
Onco-nephrology is today an established, evolving subspecialty that encompasses the complex relationship between cancer and the kidneys. Cancer may cause kidney damage through several direct or indirect mechanisms, including the involvement of renal parenchyma, volume depletion, tumor lysis syndrome, hypercalcemia, and myeloma kidney. It must be noted, that the number of nephrotoxic oncology medications has significantly increased over the last few decades [2]. The practicing nephrologist has to become familiar and develop expertise with the potential nephrotoxicity of new anticancer medications, their associated clinical and laboratory manifestations, given their wide use and the increased number of patients surviving cancer. We report here three cases which display multiple different aspects of the nephrologist’s involvement in differential renal toxicities from three commonly used new anticancer agents (aflibercept, dasatinib, and nivolumab), and discuss them in the context of the most recent literature, focusing on treatment and on the prevention/minimization of renal damage
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