Kidney cancer is the type of cancer that arises in the tissues of the kidneys. The most common type of kidney cancer in adults is renal cell carcinoma (RCC) which forms in the lining of small tubules in the kidney that filter the blood and remove waste products from the body. Transitional cell cancer (TCC) of the kidney is another type that forms at the renal pelvis which is the center of the kidney that collects urine. US National Cancer Institute estimates that more than 65000 new kidney cancers are diagnosed each year. With the use of more advanced technology in imaging techniques, smaller kidney cancers are identified which translates into overall increase in the incidence of kidney cancer. Treatment options of kidney cancer include surgical removal of kidney tissue such as minimally invasive ablation vs partial, simple or radical nephrectomy depending 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.
Chronic kidney disease (CKD) or the slow loss of kidney functions over time is both a risk factor and a complication of kidney cancer. The risk of kidney cancer especially RCC increases substantially for patients with known prior CKD reaching to 100-fold for patients with end stage renal disease. 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. A patient with a small kidney cancer is much more likely to die of complications of CKD than those related to cancer. Therefore, it is very important to identify patients who are at high risk for CKD before surgical treatment of the kidney cancer. 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 anemia, 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. Targeted cancer drugs especially antiangiogenic agents (VEGF and tyrosine kinase inhibitors) which prevent new blood vessel formation around the tumor commonly increase blood pressure and cause spilling of protein in urine (proteinuria). Both of these conditions are in the scope of a nephrologist’s expertise and managed by nephrologists in parallel to uro-oncologists.
In summary, nephrologists are important members of the multidisciplinary team that take care of patients with kidney cancer.