What is the role of nephrologist in kidney cancer?

Chronic kidney disease or the slow loss of kidney functions over time is both a risk factor and a complication of kidney cancer. Nephrectomy, surgical removal of part of kidney, puts patients at risk to develop CKD after the surgery and about 25% of patients with kidney cancer have CKD even before nephrectomy.

Nephrologists screen and identify kidney cancer patients that are at high risk of developing CKD after surgery. Nephrologists team with urologists for “before and after surgery” care of patients. Nephrologists are routinely consulted for optimization of blood pressure of kidney cancer patients, correction of anaemia, avoidance of drugs that are potentially toxic to kidneys and adequate hydration of kidneys during contrast use with computer tomography or during surgery.

Nephrologists also take part in long term follow up of patients with kidney cancers. Conventional chemotherapy, targeted cancer drugs and immunotherapy may all damage healthy kidney tissue resulting progression of CKD and electrolyte abnormalities.

Should nephrologists be involved when targeted cancer drugs are used in patients?

Conventional chemotherapy, targeted cancer drugs and immunotherapy may all damage healthy kidney tissue resulting progression of CKD and electrolyte abnormalities. Targeted cancer drugs especially antiangiogenic agents (VEGF and tyrosine kinase inhibitors) which prevent new blood vessel formation around the tumour commonly increase blood pressure and cause leakage of protein in urine. Both conditions are in the scope of a nephrologist’s expertise and managed by nephrologists in parallel to uro-oncologists.

What are kidney cancers?

Kidney cancer is the type of cancer that arises in the tissues of the kidneys, the most common being renal cell carcinoma and transitional cell cancer.

Renal cell carcinoma forms the lining of small tubules in the kidney that filter the blood and remove waste products from the body

Transitional cell cancer of the kidney is another type that forms at the renal pelvis which is the centre of the kidney that collects urine.

Treatment options of kidney cancer include surgical removal of kidney tissue such as minimally invasive ablation vs partial, simple, or radical nephrectomy depending on size and spread of the cancer which are performed by urologists. In advanced stages, medical treatments including conventional chemotherapy, targeted biological agents and immunotherapy follow surgery and are provided by uro-oncologists.