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JASON PROSEK: So the onco-nephrology clinic at Ohio State is devoted to the cancer patient that has developed a kidney complication during their treatment. There is an estimation that up to 30% of patients develop acute kidney injury during their treatment course, so there's no shortage of patients. What our clinic is devoted to is the patient that has developed acute kidney injury, electrolytes, or hypertension as a result of their cancer or their cancer chemotherapy.

So this clinic only functions as a collaborative process. And so I imagine the oncologist who has encountered an acute kidney injury patient that needs quick advice, rapid advice on how to manage this, seeing that patient in my clinic, often in that same day, we can come up with a treatment strategy together. It becomes, say, interstitial nephritis from a checkpoint inhibitor that requires steroids, then I will be taking that management of the steroid burst and steroid taper under my wing so that the oncologist doesn't have to deal with that portion of the treatment plan.

So what we found with acute interstitial nephritis of any sort, time is kidney. The longer it takes to make the diagnosis of interstitial nephritis and start treatment with steroids if required, the longer that delay, the more chronic injury that develops in the kidney. So it's crucial that there is a short feedback loop between the recognition of acute kidney injury, my evaluation, a kidney biopsy to determine that diagnosis, and get on with treatments very rapidly, can't work without collaboration and the quicker we can do all these steps, the better the outcome the patient will have and they can get on with treatment.