Pursuing an Onco-Nephrology career, Steps to take!

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Onco-Nephrology is a rapidly evolving subspeciality that covers all areas of renal involvement in cancer patients. There are several areas of contact where nephrologists and oncologists should collaborate to provide the optimum care for patients afflicted with cancer and kidney diseases. Actually, there are 10 points of contact between the 2 specialty detailed brilliantly in this lovely article (Onco-nephrology: a decalogue) and they include:
1. AKI and CKD in cancer patients
2. Nephrotoxic effects of anticancer medications
3. Paraneoplastic kidney affection.
4. Renal cell carcinoma and management of nephrectomized patients (eventually developing CKD).
5. Renal replacement therapy and oncological treatments.
6. Post-transplant malignancy
7. Kidney transplant in cancer survivors
8. Pain management in cancer patients with concomitant kidney disease.
9. Management of contrast induced AKI.
10. Prophylaxis against nephrotoxic effects of certain anticancer therapies.

Persuading a career in onconephrology require spending effort to read and learn the basics of this science as well creating an infrastructure for an outpatient onconephrology clinic with specific basic requirements to function properly.

Many valuable resources are available online to read and learn about nephrooncology including:
1. Special issue in “Seminars in Nephrology” in 2010.
2. Special issue in “CJASN Moving points in Nephrolgoy” in 2012
3. Special issue in “Advances in CKD” in 2014.
4. and finally the master of all, is the ASN onconephrology curriculum published in 2016, consisting of 19 chapters covering most of the essential Onco-Nephrology topics.

Here are some essential requirements to establish a functioning outpatient onconephrology clinic (as detailed here):
1. A sufficient number of patients enrolled in the clinic (approximately 150 patients/year).
2. Availability of (electronic) medical records and shared database between the two specialties.
3. Referral to onconephrology in cases, for example, with AKI or progressive CKD that might impede active cancer therapy.
4. A multidisciplinary approach for patients in need for mutual discussion.
5. Involvement of nurses, postgraduates, trainees and fellows to support the development and maintenance of the clinic.
6. Enhancing clinical research in the field and developing practice guidelines for the management of different situations.
7. Monitoring patients outcomes and measuring performance indicators, then reflecting on these data to improve patients care and health outcomes.

Finally, we need more nephrologists to persuade this subspeciality due to the growing demand of cancer patients. This subspeciality will improve more and more with further developments and research efforts to become more and more evidence based.

Acknowledgement: Thanks to Prof Kenar Jhaveri for providing reference .

Mohamed Elrggal
13 March 2019