Your kidneys produce hormones that control the function of other organs; regulate your body’s salt, potassium and acid levels; and remove waste and excess fluid from your body.
These processes are complex and can be affected by your diet, medications and underlying medical conditions. If you have cancer, these processes become even more complex.
Many cancer treatments place additional stress on your kidneys and can even cause them to stop working. In order to receive the most advanced cancer treatments, your kidneys must be working properly.
The Ohio State Onco-nephrology Clinic provides care to cancer patients to identify kidney complications early and fix them, so patients can continue to receive lifesaving cancer treatments.
Kidney complications from cancer
It’s estimated that almost a third of cancer patients have some degree of kidney dysfunction. Unfortunately, cancer patients who have kidney dysfunction are excluded from most clinical trials, and many will have to stop or change treatments. The Onco-nephrology Clinic helps cancer patients in Columbus, Ohio, and beyond manage kidney complications so that they can continue to receive cancer treatment.
One of the latest, frontline treatments for many cancers is a group of medications called tyrosine kinase inhibitors (TKIs). TKIs come in a pill form and are a group of targeted chemotherapies that unleash the patient’s own immune system to attack cancer cells. This super activation of the immune system also has the potential to attack healthy cells and organs in the body, including the kidneys. Since TKIs are so targeted, the side effects are also very specific, and the most common side effect is kidney complications. These complications from cancer and cancer treatments include:
- Interstitial nephritis – This is inflammation of the kidney caused by TKIs. When kidney cells are inflamed, it prevents the kidneys from filtering waste and fluid from your body and can even lead to kidney failure. Symptoms of interstitial nephritis include blood in the urine, weight gain, fever, an increase or decrease in urination, nausea, vomiting, drowsiness, confusion, rash and swelling.
- Nephrotic syndrome – Nephrotic syndrome occurs when the filters in your kidneys (glomeruli) are damaged, causing too much protein to leak into your urine. Symptoms include high blood pressure; swelling in the hands, feet and around the eyes; weight gain; pain related to blood clots or thickened blood; fever; and pee that appears foamy.
- Hypertension - When the kidneys are impaired, they have trouble filtering blood. This can lead to hypertension, also known as high blood pressure. This turns into a dangerous cycle because high blood pressure can restrict blood vessels and further prevent your kidneys from working. Most people who have high blood pressure have no symptoms but can experience significant consequences, like heart disease or stroke, if left untreated.
- Electrolyte disorders – Electrolytes – like sodium, potassium and magnesium – are minerals in the blood that help regulate blood pressure and muscle contractions and keep your body functioning. If the kidneys are not working properly, electrolytes can either be lost through urine, or too many electrolytes can build up in the body. These imbalances can have significant effects on health like hyperkalima, hypernatremia, high blood pressure and even cardiac arrest.
- Acute kidney injury – This is a sudden episode of kidney failure or kidney damage that happens in a few hours or days. Acute kidney injury can cause a buildup of waste in your body and impact other organs including the heart, brain and lungs. Patients who have acute kidney injury may experience swelling in the legs, ankles and around the eyes; decreased amount of urine; fatigue; shortness of breath; nausea; confusion; chest pain; and even seizures or coma in severe cases.
Diagnosing kidney complications from cancer and cancer treatments
Patients are typically seen at the Onco-nephrology Clinic within one week of beginning cancer treatments and experiencing kidney complications. Doctors use several tools at the Onco-nephrology Clinic to diagnose kidney complications from cancer and cancer treatments. These include:
- Blood tests – Your doctor will order a sample of your blood to be drawn and sent to a lab to be tested. Tests include arterial blood gases, blood chemistry, blood urea nitrogen and blood creatine levels, complete blood count and other indicators of your kidney function. Each test can show if there may be an issue with the way your kidneys are working.
- Urine sediment exam – Your doctor will have you collect a urine sample, which will be sent to a lab and examined under a microscope. If the kidney is shedding certain cells, casts or crystals, it could indicate a kidney problem, and those elements can end up in your pee.
- Urinalysis – Your doctor will have you collect a urine sample, which will be sent to a lab and examined for blood and protein — both of which can indicate kidney problems.
- Kidney ultrasound – An ultrasound is an imaging test that uses sound waves to see the kidneys. It can show if there are any issues with the size, shape and location of the kidneys, as well as blood flow to the kidneys.
- Kidney biopsy – The best way to determine what’s wrong with the kidneys is to perform a kidney biopsy. Your doctor will use a long needle to extract a piece of your kidney, which will then be sent to a lab and examined under a microscope. This close analysis allows your doctor to know what kind of damage there is to your kidney cells and how the damage is preventing your kidneys from working properly.
Treating kidney complications from cancer and cancer treatments
The Onco-nephrology Clinic is a collaborative effort between kidney and cancer doctors to keep patients’ kidneys functioning at their healthiest so they can receive the best possible cancer treatments.
Every cancer treatment can cause unique kidney problems, and each patient reacts differently to treatments. The goal of the Onco-nephrology Clinic is to make sure patients don’t need to be pulled off clinical trials or have their cancer treatment doses reduced. Treatment for kidney complications depends on what cancer treatments you’re receiving and what kidney problems you are experiencing.
Depending on the kidney complications you’re experiencing, your doctor may recommend a combination of the following treatments:
Medications
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These help lower blood pressure.
- Anticoagulants. These are blood-thinning medicines that may be prescribed if blood clots develop.
- Cholesterol-lowering medicines. These help lower your triglyceride and cholesterol levels.
- Corticosteroids. These reduce swelling and inflammation within the filters of the kidney (glomeruli). They can also prevent your immune system from attacking healthy cells and organs.
- Diuretics. These make you pee. They’re cautiously used to decrease the amount of swelling.
- Immune system-modifying medicines. These prevent your immune system from attacking the kidney filters (glomeruli).
Diet changes
Limiting salt and fluid in your diet can decrease swelling and reduce high blood pressure. Limiting protein in your diet can help control the buildup of waste in the blood, which can lead to acute kidney failure.
Dialysis
Dialysis is when your blood is filtered out of your body, through a machine to remove waste and excess fluid, then returned to your body. Dialysis is used only in extreme cases. If it’s necessary for cancer patients, it usually is required for only a short time.
Why choose Ohio State
The Onco-nephrology Clinic at Ohio State was one of the first clinics of its kind in the United States. Ohio State offers all newly diagnosed patients an on-site, thorough evaluation and review of treatment options. Experts from nephrology, [Add link to the main Nephrology Page] radiation oncology, surgical oncology and medical oncology help you decide on the best personalized treatment with coordinated long-term care. The clinic also gives you access to the country’s most advanced clinical trials.
Ohio State’s experience with managing kidney complications with immunotherapy treatments has identified it as a center for others to collaborate with. Currently, Ohio State is part of a multicenter consortium led by Harvard physicians to study cases of interstitial nephritis that have resulted from immunotherapy. The study will provide pioneering insights for the medical community into risk factors and best treatment strategies for interstitial nephritis resulting from immunotherapy treatments.