Onconephrology provides focused kidney care for patients with cancer
UC expert has local, international impact advancing emerging subspecialty
A University of Cincinnati physician educator is part of a growing international community establishing new standards and improving kidney care for patients with cancer, a specialty called onconephrology.
What is onconephrology?
Prakash Gudsoorkar, MD. Photo/Andrew Higley/UC Marketing + Brand.
UC’s Prakash Gudsoorkar, MD, said onconephrology is a relatively new subspecialty dedicated to safeguarding kidney health from the adverse effects of cancer and cancer treatments. Onconephrologists like Gudsoorkar provide care to this unique subset of patients being treated for cancer or who are cancer survivors with associated kidney-related issues.
"This specialty is about understanding the impact of cancer and its therapies on various aspects of kidney function,” said Gudsoorkar, assistant professor and medical director of Onconephrology Service in the Division of Nephrology in UC’s College of Medicine. "We are uncovering more about the impact on kidney function, linked to existing and new chemotherapy, immunotherapy and cellular therapy agents.”
Gudsoorkar said he first became interested in onconephrology while at Toronto’s Princess Margaret Cancer Center and Toronto General Hospital (affiliated with the University of Toronto, Canada), where he completed his general nephrology and kidney transplant fellowship.
“At that time, on a consult list of up to 35 or 40 patients, we used to have 8 or 10 patients who had various forms of drug toxicities from chemotherapy agents and immunotherapy agents or acute kidney injury following bone marrow transplantation,” he said.
Gudsoorkar continued to have an interest in onconephrology when he came to UC, sporadically providing consults to patients in partnership with University of Cincinnati Cancer Center oncologists in his general nephrology clinic. In June 2023, he formally launched an Onconephrology Clinic at Hoxworth Blood Center, where he sees patients twice a month.
You monitor them as you would typically monitor any other patient with kidney disease, but one needs to be mindful of the complex interplay between cancer, its therapies and kidney function.
Prakash Gudsoorkar, MD
“I can cater to all of these patients with complex issues under one roof,” he said. “So you monitor them as you would typically monitor any other patient with kidney disease, but one needs to be mindful of the complex interplay between cancer, its therapies and kidney function.”
Gudsoorkar manages a comprehensive program for patients with kidney cancer who have undergone nephrectomy (the surgical removal of kidneys), addressing chronic kidney disease (CKD) and proteinuria (elevated protein in the urine). His expertise extends to managing kidney toxicity from immunotherapy, conventional chemotherapy and cellular therapy.
In his practice, Gudsoorkar also treats paraproteinemia-related kidney diseases such as myeloma and amyloidosis and assesses kidney disease risk before and after a bone marrow transplant. Additionally, he handles electrolyte disorders and hypertension from molecularly targeted therapies and engages in ethical discussions about dialysis for patients with cancer.
With his background in kidney transplantation, Gudsoorkar aims to expand the service to include post-kidney transplant malignancy care, focusing on transplant onconephrology. He estimated about 25% to 30% of patients who are treated with various forms of cancer therapies need some sort of nephrology care and/or ongoing kidney care following treatment.
Setting standards, international impact
Because onconephrology is a relatively new subspecialty, there is a need for education, collaboration and research both to set standards of care and to move the field forward.
In 2021 and 2022, Gudsoorkar and colleagues from Mass General Hospital and Northwell Health, New York, guest-edited a two-part onconephrology series of 26 review articles from more than 75 authors from North America, Europe and India that significantly advanced the body of knowledge in onconephrology.
He is also a member of the newly formed American Society of Onconephrology (ASON), serving on its education and position statement committee. Gudsoorkar additionally serves on the American Society of Nephrology’s onconephrology working group and the International Society of Nephrology—Young Nephrologist Committee workforce to devise the onconephrology curriculum.
“ASON plays a pivotal role in advancing onconephrology and is instrumental in developing guidelines and position statements that guide clinical practice and research priorities,” Gudsoorkar said.
Along with ASON colleagues, Gudsoorkar recently coauthored a two-part manuscript published in the Clinical Journal of ASON providing guidance on standardizing estimated glomerular filtration rate (eGFR) for patients with cancer.
The relatively new subspecialty of onconephrology focuses on the kidney health of patients being treated for cancer or cancer survivors.
Simply put, eGFR uses a mathematical equation and several variables to estimate a person’s kidney function. While it’s not a precise measurement, an eGFR of 70 indicates approximately 70% kidney function, Gudsoorkar explained.
Gudsoorkar said few studies have systematically looked at kidney function estimation for patients with cancer, so ASON put together the position statement to provide more uniformity and clarity to oncologists and onconephrologists.
“If you’re underestimating kidney function, you will underdose and undertreat the patient,” he said. “If you’re overestimating the kidney function, you will probably overdose the drug, which might lead to toxicity.”
As he continues to play a role in the international conversation moving onconephrology care forward, Gudsoorkar trains and mentors fellows and residents and participates in collaborative studies with oncologists about kidney-related outcomes in cancer treatments at UC.
In the long term, he sees onconephrology as a core part of survivorship support for patients, in addition to primary care, cardiology, pediatric to adult cancer survivorship and other supportive services.
“Organs such as the kidneys, heart and endocrine system are adversely affected by cancer and its treatments. Therefore, physicians caring for this vulnerable population must adopt a multidisciplinary approach across various specialties to safeguard their organ health effectively,” he said.
Gudsoorkar credits support from division chair Amit Govil, MD, nurse clinician Alice Doren, medical assistant Deasia Jackson and other clinic support staff for helping efficiently manage and grow the Onconephrology Clinic.
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Featured photo at top of a model of a kidney. Photo/Robina Weermeijer/Unsplash.
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