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This study provides a review of the interaction between cancer and kidney disease to develop nephroprotective strategies during chemotherapy.

The inter-relationship between cancer and kidney disease emphasizes the importance of onco-nephrology. Chemotherapeutic agents can affect renal function and result in acute kidney injury (AKI) or chronic kidney disease (CKD) in cancer survivors. Moreover, the co-existence of CKD with cancer decreases the likelihood of patients receiving optimal therapy. A study in the journal Cancers reviewed this nephrology–oncology connection.

Potential Biomarker for Renal Dysfunction in Cancer

Albuminuria, an early biomarker of renal dysfunction, is increased in certain cancers. Studies show a direct correlation between an elevated urinary albumin-to-creatinine ratio and cancer incidence. Glomerular disease can be a paraneoplastic manifestation, with membranous nephropathy (MN) being the most common cancer-associated glomerulopathy. Auto-antibodies can differentiate primary and secondary MN; however, research shows ambivalent results.

The main criteria for defining a causal relationship between MN and cancer should include their simultaneous or close diagnosis, remission of proteinuria with cancer treatment, and recurrence with cancer relapse. Other glomerulopathies, such as minimal change glomerulonephritis, focal segmental glomerulosclerosis, rapidly progressive glomerulonephritis, membranoproliferative glomerulonephritis, and immunoglobulin A nephropathy, have been linked to various solid tumors and hematological malignancies.

Acute Kidney Injury Risk in Cancer Patients

AKI is the most common nephrological manifestation in cancer patients and increases morbidity and mortality. It can also affect the efficacy and safety of chemotherapy. Multiple factors contribute to the development of AKI, including cancer type, drugs, and patient characteristics. Cisplatin, a commonly used anti-cancer drug, exerts nephrotoxic effects through tubular damage. Newer treatments, like immunotherapies and targeted cancer therapies, can lead to immune-mediated kidney injury. Additional nephrotoxic medications and contrast agents should be avoided to reduce AKI risk in cancer patients.

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Hematopoietic Stem Cell Transplantation and Other Causes

Hematopoietic Stem Cell Transplantation (HSCT) is a life-saving cancer treatment associated with a high risk of AKI and CKD, leading to increased mortality. AKI mainly occurs within the first month of HSCT, precipitated by factors such as sepsis, nephrotoxic drugs, and hepatic sinusoidal obstructive syndrome. Prevention and treatment strategies include hydration, careful use of nephrotoxic medications, monitoring renal function, and specific therapeutic agents.

CKD incidence post-HSCT varies but progresses faster than in the general population. Risk factors for CKD post-HSCT include old age, female gender, pre-existing reduced glomerular filtration rate (GFR) and glomerulopathies, use of pharmacotherapy based on calcineurin inhibitors, and thrombotic microangiopathy.

Other causes of AKI in cancer patients include urinary tract obstruction by cancer, dysproteinemias, and tumor lysis syndrome (TLS). Electrolyte disorders, common in cancer due to chemotherapy, TLS, and hormonal imbalances, require monitoring and timely treatment.

Chemotherapy in Chronic Kidney Disease

Renal function evaluation is crucial when administering chemotherapeutic drugs. CKD patients exhibit altered pharmacokinetics, increasing the risk of side effects. Therefore, GFR-based chemotherapeutic dose adjustment is needed in these patients.   

Source

Noce, A., Marrone, G., Di Lauro, M., Mitterhofer, A. P., Ceravolo, M. J., Di Daniele, N., Manenti, G., & De Lorenzo, A. (2023). The Onco-Nephrology Field: The Role of Personalized Chemotherapy to Prevent Kidney Damage. Cancers, 15(8), 2254. https://doi.org/10.3390/cancers15082254