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Cancer in renal transplant patients

Introduction Renal transplantation remains the treatment of choice for eligible candidates with end-stage renal disease (ESRD), because it offers improved quality and increased quantity of life to these patients. In the early days of renal transplantation, the lack of potent immunosuppressants resulted in very high acute rejection rates leading to early graft loss and overall poor graft and patient survival. Since the advent of potent immunosuppressants…

Incidence of cancer and screening recommendations

Introduction The purpose of cancer screening is to identify treatable cancers early to improve survival. Effective cancer screening therefore depends on cancer occurrence and risk, the availability and effectiveness of cancer screening tools, and expected survival in a given population. Cancer screening is beneficial if the screening tests used identify early stage, potentially curable cancers in individuals who have long expected survival in the absence of…

Chronic kidney disease as a complication of cancer, with special focus on kidney and urothelial tumors

The prevalence of chronic kidney disease in cancer patients The prevalence of chronic kidney disease (CKD) is reported to be high in patients with malignancy, being 33% and 27% according to Dogan et al. and Launay-Vacher et al., respectively. But the prevalence of CKD stage 3 or more is 20% after age 60 years, and it is 45% after age 70 years; furthermore, cancer is also…

Renal replacement therapies

Introduction Acute kidney injury (AKI) occurs commonly in cancer patients and independently increases morbidity and mortality. , Despite impressive gains in the understanding of the basic pathophysiologic principles underlying kidney injury, there are no therapeutic options to prevent or ameliorate AKI; treatment consists of supportive care and avoidance of nephrotoxic agents, such as radiocontrast and nonsteroidal antiinflammatory agents. Patients with cancer are at risk for the…

Obstructive nephropathy in cancer

Introduction Acute and chronic renal impairment resulting from urinary tract obstruction is common among patients with cancer and not solely limited to patients with pelvic tumors. Unlike benign causes of urinary tract obstruction, urinary obstruction resulting from malignancies poses several unique clinical challenges. The rate of recurrence of the obstruction and complications from measures undertaken to relieve the obstruction, tends to be higher in the cancer…

Tumor lysis syndrome

Introduction Tumor lysis syndrome (TLS) describes the series of metabolic events that result from the death of rapidly dividing cancer cells. When cancer cells die, either spontaneously or in response to chemotherapy, they lyse and release intracellular contents of electrolytes, nucleic acids, and proteins. These substances accumulate in the systemic circulation and cause multiorgan pathology either directly or via toxic metabolites. Clinically, patients may experience electrolyte…

Acute kidney injury incidence, pathogenesis, and outcomes

Introduction Advances in therapy, risk stratification, and supportive care have improved survival of patients with cancer over the past 2 decades. Acute kidney injury (AKI) remains a common complication of cancer treatment and entails increased length of stay, cost, and mortality. , In addition, AKI may also lead to decreased functional status, decreased quality of life, and exclusion from further cancer therapy or trials. The etiology…

Evaluation of a renal cyst/mass

Introduction Epidemiology and risk factors Renal cell carcinoma (RCC) is the eighth most common malignancy in the world. According to the National Cancer Institute, in 2017 approximately 64,000 diagnoses were made in the United States and more than 330,000 worldwide. The incidence of RCC has been steadily increasing in the United States, but this may be caused by incidental detection from imaging studies. In the 1980s,…

Tuberous sclerosis complex and the kidney

Introduction Tuberous sclerosis complex (TSC) is an often underdiagnosed and misunderstood disease affecting more than one million patients worldwide. Disruptions in the TSC axis lead to cellular abnormalities that result in abnormal development and postpartum cellular growth. TSC affects every organ system and is often thought of as a tumor predisposition syndrome, although the lesions often seem to share characteristics of more benign lesions, and in…

Wilms tumor and von Hippel Lindau disease

Introduction Nephroblastoma, or Wilms tumor (WT), is the most common primary renal malignancy in childhood and represents 6% of all childhood cancers. WTs comprise over 95% of all kidney tumors in children younger than 15 years old. , Usually found in children 1 to 5 years old, the tumor is still a rare finding. Overall, the incidence of WT is 1 in 10,000 children under 5…

Renal cell cancer

Introduction Kidney cancer, or renal cell carcinoma (RCC), is the most common malignancy seen in the practice of nephrology. It is one of the relatively few cancers whose incidence is increasing despite our growing knowledge of the associated risk factors, yet the study of this disease within nephrology pedagogy and continuing education is woefully lacking. Although there are many subtypes of RCC, the most common by…

Hematologic malignancies

Paraneoplastic glomerulopathy in hematologic malignancies Paraneoplastic syndromes in the context of hematologic malignancies have been reported among multiple organ systems, including the nervous system, skin, bone marrow, and kidneys. Paraneoplastic glomerular injury has been demonstrated to be the result of tumoral production of cytokines, monoclonal and amyloid proteins, cryoglobulins, and the development of autoimmune diseases. Direct leukemic or lymphomatous infiltration of the kidney will not be…

Paraneoplastic glomerulonephritis

Introduction Paraneoplastic syndrome refers to “clinical manifestations that are not directly related to tumor burden, invasion or metastasis, but are caused by secretion of tumor cell products, such as hormones, growth factors, cytokines and tumor antigens.” The idea that the kidneys could manifest paraneoplastic disease was first proposed in 1922 by Galloway who noticed the presence of an “unusual protein” in the urine of his patient…

Paraneoplastic glomerular diseases

Introduction Paraneoplastic syndromes refer to manifestations of cancer that are not related to tumor burden, invasion, or metastatic disease. The manifestations may be systemic or organ-limited and can involve virtually any organ system. There is a paucity of literature on paraneoplastic kidney disease (PnKD), likely because of the rarity of these conditions. This narrative review will focus on PnKDs that occur in the setting of solid…

Radiation nephropathy

Definition Radiation nephropathy is the kidney parenchymal injury and loss of function caused by radiation exposure to the kidneys. Its typical form is caused by external beam ionizing radiation, by x-rays or gamma-rays. It may also be caused by radioisotope therapies that irradiate kidneys internally. It is not common in current clinical practice but remains a risk of accidental or belligerent radiation exposures. The term nephropathy…

Chemotherapy in chronic kidney disease and dialysis

Malignancy remains a major cause of morbidity and mortality in the United States. It is estimated that up to 1,735,350 new cases of cancer will be diagnosed in 2018, with 609,640 deaths from cancer predicted for that year. On the other hand, survival in cancer patients has improved dramatically, with a 5-year survival of 66.9% in 2008 to 2014. Many of these cases will be diagnosed…

Adverse kidney effects of immunotherapies

Introduction The scope of oncology has changed greatly over the past decade as therapies for cancer have moved toward creating or intensifying an immune response against it. The ever-growing number of therapies uses a multitude of different mechanisms, including blockade of specific immune checkpoints, manipulation of T-cells, or direct stimulation of the immune system to enhance killing of tumor cells. Many of the newly available cancer…

Targeted cancer therapies (biologics)

Introduction In the past decade, advances in cell biology have led to the development of anticancer agents that target specific molecular pathways. The National Cancer Institute (NCI) defines targeted therapies as “drugs or substances that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression.” Targeted therapies are now commonly used in cancer treatment and it is vital…

Conventional chemotherapy

Introduction Several conventional chemotherapeutics have been associated with renal side effects including kidney function deterioration, electrolyte disorders, tubular injury, glomerular lesions, tubulointerstitial nephritis, and the development of thrombotic microangiopathy (TMA) ( Tables 16.1–16.3 ). Multiple risk factors for chemotherapy-induced nephrotoxicity have been identified ( Box 16.1 ). The quality of data available regarding these kidney side effects is low, because subtle kidney damage goes frequently unrecognized…