Pediatric onco-nephrology: time to spread the word
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EDUCATIONAL REVIEW
Pediatric onco-nephrology: time to spread the word Part I: early kidney involvement in children with malignancy Arwa Nada 1
&
Jennifer G Jetton 2
Received: 21 May 2020 / Revised: 28 August 2020 / Accepted: 25 September 2020 # IPNA 2020
Abstract Onco-nephrology has been a growing field within the adult nephrology scope of practice. Even though pediatric nephrologists have been increasingly involved in the care of children with different forms of malignancy, there has not been an emphasis on developing special expertise in this area. The fast pace of discovery in this field, including the development of new therapy protocols with their own kidney side effects and the introduction of the CD19-targeted chimeric antigen receptor T cell (CAR-T) therapy, has introduced new challenges for general pediatric nephrologists because of the unique effects of these treatments on the kidney. Moreover, with the improved outcomes in children receiving cancer therapy come an increased number of survivors at risk for chronic kidney disease related to both their cancer diagnosis and therapy. Therefore, it is time for pediatric onconephrology to take its spot on the expanding subspecialties map in pediatric nephrology. Keywords Cancer . Wilms tumor . Kidney injury . Chemotherapy . CAR-T . Contrast nephropathy . Children
Why pediatric onco-nephrology, why now? Onco-nephrology (ON) is an emerging medical subspecialty focused on the numerous interconnections between cancer and kidney disease. The outstanding progress in the treatment of malignancy has created new therapeutic challenges for both oncologists and nephrologists. Nephrologists have traditionally been involved in treating the kidney-related complications of patients with cancer such as acute kidney injury (AKI), fluid and electrolyte disturbances, tumor lysis syndrome (TLS), hypertension (HTN), and chronic kidney disease (CKD). However, the rapid development of new anticancer drugs with nephrotoxic effects and the introduction of the CD19-targeted chimeric antigen receptor T cell (CAR-T) therapy have added more challenges and require more specialized knowledge on the part of the treating nephrologist.
* Arwa Nada [email protected] 1
Division of Nephrology, Department of Pediatrics, Le Bonheur Children’s Hospital & Saint Jude Research Hospital, The University of Tennessee Health Science Center, TN Memphis, USA
2
Division of Nephrology, Department of Pediatrics, Stead Family Children’s Hospital, The University of Iowa, IA Iowa, USA
Recognizing these challenges, the American Society of Nephrology (ASN) hosted the first Onco-Nephrology Forum (ONF) in 2012. Since then, the field of ON has grown to include many publications focusing on nephrology issues in cancer patients, numerous conference proceedings, journal issues devoted to the field of ON, and dedicated society meetings (Fig. 1). While cancer is not nearly as common in children as it is in adults, pediatric nephrologists are becoming increasingly involved in mitigating the short-term and long-term e
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