Nephrology and Dialysis Unit, Department of Medical Sciences, Sant'Andrea Hospital, II Faculty of Medicine, Sapienza University of Rome, Rome, Italy.
Contrib Nephrol. 2021;199:91-105. doi: 10.1159/000517695. Epub 2021 Aug 10.
Clinical Background: Cancer therapeutics (for both solid and hematological malignancies) have evolved over the last two decades, from traditional chemotherapies to novel treatments. A better supportive care, older patients with comorbidities who receive multiple chemotherapeutic and pharmacological regimens, multiple CT scans with contrast agents, and new therapeutic options are also increasing the number of cancer patients who can develop acute kidney injury (AKI) or chronic kidney disease (CKD). Challenges: Targeted therapies and immunotherapies, which harness the body's own immune system to fight cancer cells have led to improved survival in cancer patients, yet all are associated with many organ toxicities. Renal toxicity is mainly represented by acute tubular-interstitial damage, glomerular lesions, thrombotic microangiopathy, tumor lysis, proteinuria, arterial hypertension, AKI, CKD, and secondary fluid/electrolyte disturbances. On the other hand, it is important to consider how the presence of CKD, AKI, and other renal disorders may affect treatment options for the oncologists and patient's outcome. All these features require a specialized approach. Prevention and Treatment: A new evolving field, namely Onconephrology, has emerged during the last few years, including the broad spectrum of renal disorders that can arise in patients with cancer. Nephrologists have become an indispensable part of the multidisciplinary cancer care teams, but a clear and updated knowledge of solid and hematological malignancies, always new anticancer therapies, and their relationships with kidney function is essential to ensure the highest quality of care. In this chapter, we summarize the principal aspects of this new field of Nephrology.
在过去的二十年中，癌症治疗（包括实体瘤和血液系统恶性肿瘤）已经从传统的化疗发展到了新的治疗方法。更好的支持性护理、患有合并症的老年患者接受多种化疗和药物治疗方案、多次使用造影剂的 CT 扫描以及新的治疗选择，这些都增加了可能发生急性肾损伤（AKI）或慢性肾脏病（CKD）的癌症患者数量。
靶向治疗和免疫疗法利用人体自身的免疫系统来对抗癌细胞，从而提高了癌症患者的生存率，但所有这些疗法都与许多器官毒性有关。肾毒性主要表现为急性肾小管间质性损伤、肾小球病变、血栓性微血管病、肿瘤溶解、蛋白尿、动脉高血压、AKI、CKD 和继发性液体/电解质紊乱。另一方面，重要的是要考虑 CKD、AKI 和其他肾脏疾病的存在如何影响肿瘤学家的治疗选择和患者的预后。所有这些特征都需要一种专门的方法。
近年来出现了一个新的发展领域，即肿瘤肾脏病学，包括癌症患者可能出现的广泛的肾脏疾病。肾病学家已经成为多学科癌症护理团队不可或缺的一部分，但对实体瘤和血液系统恶性肿瘤、不断出现的新抗癌疗法及其与肾功能的关系有明确和最新的认识，对于确保最高质量的护理至关重要。在本章中，我们总结了肾脏病学这一新领域的主要方面。
