The Onco-Nephrology Field: The Role of Personalized Chemotherapy to Prevent Kidney Damage

SIMPLE SUMMARY: The onco-nephrology field: the interaction between cancer and kidney disease emphasizes the nephrology–oncology connection. This narrative review focuses on several aspects of this association. First of all, the availability of more effective chemotherapeutic agents, including stem cell therapies and biological drugs, has enhanced the survival of cancer patients. These therapeutic advances ameliorate the outcomes of cancer patients; nevertheless, they could induce secondary effects on renal function. As a consequence, some cancer survivors develop chronic kidney disease (CKD). On the other hand, the coexistence of CKD with cancer reduces the likelihood that cancer patients receive either the optimal anticancer therapy or the supportive care. Nephrologists should be aware of it, starting from an early cancer diagnosis; thus, it is important to set up nephroprotective supportive strategies to avoid the onset of acute kidney injury or the CKD worsening. ABSTRACT: In recent years, the onco-nephrology field has acquired a relevant role in internal medicine due to the growing number of cases of renal dysfunction that have been observed in cancer patients. This clinical complication can be induced by the tumor itself (for example, due to obstructive phenomena affecting the excretory tract or by neoplastic dissemination) or by chemotherapy, as it is potentially nephrotoxic. Kidney damage can manifest as acute kidney injury or represent a worsening of pre-existing chronic kidney disease. In cancer patients, physicians should try to set preventive strategies to safeguard the renal function, avoiding the concomitant use of nephrotoxic drugs, personalizing the dose of chemotherapy according to the glomerular filtration rate (GFR) and using an appropriate hydration therapy in combination with nephroprotective compounds. To prevent renal dysfunction, a new possible tool useful in the field of onco-nephrology would be the development of a personalized algorithm for the patient based on body composition parameters, gender, nutritional status, GFR and genetic polymorphisms.