Yale Nephrology officially established a new clinical and research program in October 2022. The Onco-Nephrology program within the Department of Internal Medicine’s Section of Nephrology, treats people with kidney-related complications as a result of cancer or treatment of cancer. While patient care is the primary focus of the program, clinical research is also part of the long-term plan of the program, which is a joint endeavor with Yale New Haven Hospital.
“Patients who have kidney-related complications now have not just one, but two dedicated physicians who will partner with their oncologist to continue their cancer care,” said Anushree C. Shirali, MD, associate professor of medicine (nephrology) who has been seeing patients from Smilow Cancer Hospital and the Smilow Cancer Network as well as private oncology practices since 2011. ”Our job is to see patients who have a diagnosis of malignancy, most of whom are on active treatment, who end up having some sort of kidney-related complication that needs attention so that therapy is not delayed or stopped unnecessarily.”
Niloufar Yarandi, MD, assistant professor of medicine (nephrology), who has completed an advanced fellowship in Onco-Nephrology, also treats patients through the program. “The goal of Onco-Nephrology at Yale is to collaborate with other teams providing care to patients with cancer who have any type of kidney complication in a variety of ways,” Yarandi explained.
The number of patients who are being referred for cancer treatment has exponentially increased in the last several years as people are living longer. “As they do, and as they're exposed to both old as well as new modes of therapies, they unfortunately will sometimes have adverse events,” Shirali said.
Shirali and Yarandi usually can see a patient within one or two weeks of their oncologist’s referral. “We are pretty diligent, especially if it's an urgent consult,” said Shirali. The goal is to provide recommendations so that patients can resume their treatments.
Shirali, who is also the medical director of both the peritoneal dialysis unit and the hemodialysis unit in Hamden, treats dialysis patients as well as patients with chronic kidney disease who develop a malignancy and are candidates for cancer treatment. However, the dosing and the frequency of chemotherapies are not well-defined in dialysis patients or patients with advanced chronic kidney disease. “You're constantly trying to find the balance between toxicity and efficacy,” Shirali said. “For those patients, I think it's indispensable to have a onco-nephrologist.”
Patient Care
The Yale Onco-Nephrology clinic is an advanced subspeciality nephrology clinic that provides consultation for the following:
- Management of chronic or acute kidney disease in patients with cancer
- Kidney complications related to cancer therapies: Chemotherapy, Targeted therapy, Immunotherapy, CAR T therapy, Stem Cell Transplant
- Drug dosing in cancer patients with chronic kidney disease or end-state kidney disease
- Electrolyte disturbances in cancer patients
- Kidney diseases related to monoclonal gammopathy, Multiple Myeloma, Amyloidosis