The basics of onco-nephrology in the renal clinic
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The basics of onco‑nephrology in the renal clinic Laura Cosmai1 · Camillo Porta2,3 · Marina Foramitti4 · Mimma Rizzo5 · Maurizio Gallieni1,6
© Italian Society of Nephrology 2020
Abstract Onconephrology is a rapidly evolving subspecialty that covers all areas of renal involvement in cancer patients. The complexity of the field may benefit from well-defined multidisciplinary management by a dedicated team. Patients with cancer frequently suffer from concurrent chronic kidney disease (CKD), with a prevalence ranging from 12% to 53% at the time of cancer diagnosis. Taking into account the incidence of cancer and the prevalence of CKD in the Italian population, we estimate that about 44,000 patients suffered from both diseases in 2020. Since there is an increasing necessity to address the needs of this population in dedicated outpatient clinics, it is critical to highlight some basic characteristics and to suggest areas of development. Our experience in the nephrological management of cancer patients clearly suggests the need to implement dedicated multidisciplinary teams and to create onconephrology clinics (at least within larger, referral, hospitals). Furthermore, it must be kept in mind that not only is CKD common in cancer patients, but also that the concomitant presence of these two conditions too often excludes cancer patients from clinical trials, thus limiting their access to therapies that could potentially improve their outcomes. Indeed, the Renal Insufficiency and Cancer Medications (IRMA) study found that cancer patients with CKD or on dialysis are often undertreated, or are exposed to either ineffective or toxic anticancer agents. Finally, the aim of this article is to initiate a debate about what an onconephrology outpatient clinic might look like, in order to ensure the highest quality of care for this growing patient population. Keywords Onconephrology · Kidney diseases · Cancer · Oncological treatments · Multidisciplinary team
Introduction
Laura Cosmai and Camillo Porta are co-first authors. * Laura Cosmai [email protected] 1
Nephrology and Dialysis Unit, Onco-Nephrology Outpatient Clinic, ASST Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Piazzale Principessa Clotilde, 320121 Milan, Italy
2
Chair of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro, Bari, Italy
3
Policlinico Consorziale di Bari, Bari, Italy
4
Division of Nephrology and Dialysis, ASST Cremona, Cremona, Italy
5
Division of Translational Oncology, IRCCS Istituti Clinici Scientifici ‘Maugeri’, Pavia, Italy
6
Department of Biomedical and Clinical Sciences ‘L. Sacco’, University of Milan, Milan, Italy
Onconephrology is a relatively new, but rapidly evolving, subspecialty of internal medicine focusing on the complex, and too often neglected, relationships between the kidneys and cancer. This relationship has been described as ‘circular’ [1] since the presence of a tumor or of its treatments may, directly or indirectly, impair renal function [2]. On the other hand, t
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