By Pat Carragher - March 26, 2021
In 2015, Moffitt Cancer Center introduced its Onco-Nephrology Program to screen and identify kidney cancer patients who have a high risk of developing chronic kidney disease (CKD) after surgery. The program was one of the first of its kind to be established in Florida. Since then, the program has expanded its clinical service to better accommodate the needs of our patients.
A multidisciplinary team, including physicians from Urology and Onco-Nephrology, collaborate to ouline care for patients who have undergone a nephrectomy, which is a full or partial kidney removal surgery. These surgical patients can have a higher risk of developing CKD, which can cause a loss of kidney function over time. About 25% of kidney cancer patients can develop CKD, even before surgery. Onco-Nephrologists can help patients by optimizing their kidney function, adjusting their blood pressure, anemia and avoid potentially harmful medications.
“Chronic kidney disease is not just a diagnosis,” said Dr. Claude Bassil, an Onco-Nephrologist at Moffitt. “We need to make sure a patient who survives cancer will have a good life and good kidney function. Having optimal kidney function will help patients become eligible for chemotherapy or immunotherapy to improve their survival.”
"We need to make sure a patient who survives cancer will have a good life and good kidney function. Having optimal kidney function will help patients become eligible for chemotherapy or immunotherapy to improve their survival."- Dr. Claude Bassil
One of the leading risk factors for worsening of kidney function following a total nephrectomy is the contrast dye used to monitor disease progression. These dyes are used in diagnostic tests such as CT scans and can help provide valuable information for diagnosing and treating kidney cancer. Unfortunately these dyes can also potentially cause injury to the kidneys.
“The contrast itself once exposed to the kidneys can cause acute and even chronic deterioration in renal function, most notably in patients with underlying renal impairment/dysfunction,” said Dr. Philippe Spiess, assistant chief of Surgical Services and senior member of the Department of Genitourinary Oncology at Moffitt. “That toxicity can be irreversible and could even require the necessity for long-term dialysis.”
In an effort to lower the risks associated with these dyes, Spiess and Bassil have developed a protocol for hydrating patients though IV fluids before and after testing to help the kidneys better filter and wash out the dyes whereby minimizing this risk of renal damage from such imaging studies.
“We can hydrate patients over a short period of time so that some of these toxins get less contact time and cause less toxicity to individual nephrons at risk of damage,” said Spiess. “So when we get the scans there's a lower risk that they're going to have problems with kidney dysfunction afterwards.”
Onco-Nephrologists also take part in the long term follow up care of kidney cancer patients. Chemotherapy, cancer drugs and immunotherapy can all be potentially harmful to kidney function.
“We’re not waiting for bad events to happen,” said Spiess. “Part of what we do here at Moffitt is multidisciplinary care. It’s not just a surgeon, a medical oncologist or a radiation therapist. It's other medical specialties working together to provide the best possible care of our patients.”