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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2016  |  Volume : 27  |  Issue : 4  |  Page : 823-824
The onconephrology: Our experience in cancer patients


1 Department of Nephrology-Dialysis, Civico and Di Cristina Hospital, Palermo, Italy
2 Department of Oncological Medicine, Civico and Di Cristina Hospital, Palermo, Italy

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Date of Web Publication5-Jul-2016
 

How to cite this article:
Li Cavoli G, Rondello G, Li Cavoli TV, Rotolo U. The onconephrology: Our experience in cancer patients. Saudi J Kidney Dis Transpl 2016;27:823-4

How to cite this URL:
Li Cavoli G, Rondello G, Li Cavoli TV, Rotolo U. The onconephrology: Our experience in cancer patients. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2021 Oct 19];27:823-4. Available from: https://www.sjkdt.org/text.asp?2016/27/4/823/185282
To the Editor,

Onconephrology, new medical discipline rapidly growing in recent years, studies the interrelations between cancer and kidney diseases. Our experience: from 2004 to 2014, among 3000 outpatients in Oncological Medicine Department in Palermo, Italy, we performed a collaborative relationship between oncologists and nephrologists to minimize renal complications. The malignancies more frequently treated were breast cancer, lung cancer, and colon cancer. Like other reports [1],[2] also in our experience chronic kidney disease (CKD) was very common in cancer patients. The most of these subjects (80%) had a reduced glomerular filtration rate. The prevalence of Stage 2-5 CKD, excluding patients on chronic dialysis, was high and, respectively, 40%, 25%, 13%, and 2%. This distribution reflects the higher prevalence of cancer in elderly patients. Based on the modification of diet in renal disease (MDRD) and CKD-epidemiology formulas, we routinely applied the dose adjustment of medications for prevailing glomerular filtrate rate to optimize drug exposure and reduce the risk of side effects. Because of formal data on renal or dialysis clearance for the most of the anticancer drug are scarce and often incomplete and few studies are available to validate the dosing recommendations, we determined individually the treatment protocol for patients on long-term hemodialysis. Subjects with malignancies are prone to acute kidney injury (AKI) as a consequence of both their underlying disease and its treatment. Acute renal failure is reported to occur in up of 50% critically ill neoplastic subjects. [3],[4] Moreover, in our experience, kidney cancer, multiple myeloma, and liver cancer had the highest one-year risks of AKI. In the past years, in patients starting chemotherapy, there was a high incidence of prerenal azotemia but in recent years, correction of volume depletion prevented this mechanism of kidney damage. Nephrotoxicity remains a vexing complication of chemotherapeutic agents but discontinuation of therapy and effective volume management often readily reverses the renal failure. After the use of chemotherapeutic agents (cisplatin, ifosfamide, and methotrexate), we saw seven cases of AKI; in four cases needed dialysis, but all cases recovered renal function. Not all patients exposed to nephrotoxic chemotherapeutic agents develop kidney injury suggesting the presence of several factors that enhance patient risk for nephrotoxicity. Nausea, vomiting, and diarrhea often produce fluid and electrolytes abnormalities in patients with malignancies on chemotherapy. Doshi et al reported hyponatremia in nearly 50% of hospitalized patients with cancer. [5] During the observed period, we identified 20 cases of fluid, electrolytes, and acid-base disturbances, due to myelomaor drug-induced tubulopathy. Never we observed severe (<120 mEq/L) hyponatremia; moderate (129-120 mEq/L) hyponatremia was treated successfully with saline solution infusion likewise to that in noncancer settings. Hypercalcemia, unrelated to osteolytic metastases, was a rare abnormality (five cases) and responded favorably to saline infusion, steroid, and bisphosphonates. We did not observe glomerulopathy as a paraneoplastic syndrome; we observed 10 cases of hypertrophic pulmonary osteoarthropathy (digital clubbing) in lung cancer and two cases of tumor lysis syndrome in hematological malignancies.

In summary, in our experience the collaborative relationship between oncologists and nephrologists has increased cancer cure rate and survival time in cancer patients with renal abnormalities.

Conflict of interest: None declared.

 
   References Top

1.
Sahni V, Choudhury D, Ahmed Z. Chemotherapy-associated renal dysfunction. Nat Rev Nephrol 2009;5:450-62.  Back to cited text no. 1
[PUBMED]    
2.
Perazella MA, Moeckel GW. Nephrotoxicity from chemotherapeutic agents: Clinical manifestations, pathobiology, and prevention/therapy. Semin Nephrol 2010;30:570-81.  Back to cited text no. 2
[PUBMED]    
3.
Lameire NH, Flombaum CD, Moreau D, Ronco C. Acute renal failure in cancer patients. Ann Med 2005;37:13-25.  Back to cited text no. 3
[PUBMED]    
4.
Lam AQ, Humphreys BD. Onco-nephrology: AKI in the cancer patient. Clin J Am Soc Nephrol 2012;7:1692-700.  Back to cited text no. 4
[PUBMED]    
5.
Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK. Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 2012;59:222-8.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Dr. Gioacchino Li Cavoli
Department of Nephrology-Dialysis, Civico and Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.185282

PMID: 27424709

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