Anushree Shirali, MD, is a nephrologist who specializes in Onco-nephrology, a new and growing subspecialty dedicated to the care of people who have both kidney disease and cancer. “The implication of kidney disease can be big for their cancer therapy, because we are always looking at whether it is related to their treatment,” she says.
Cancer patients sometimes worry that Dr. Shirali will tell them a lifesaving immunotherapy or chemotherapy treatment they are taking is damaging their kidneys and they can no longer use the drugs. “That’s not really the case,” she says. “Our work is usually about management. There are medications that you can use to reverse kidney damage, particularly in cases where patients are receiving immunotherapy.”
After starting her career as a general nephrologist, Dr. Shirali began working with cancer patients about a decade ago, after Smilow Cancer Hospital at Yale New Haven opened, and started the Onco-nephrology specialty clinic at Yale. “This was a relatively new area in nephrology at the time and it drew me because of the complex problems it dealt with in patients facing cancer,” she says. “For me it was a very personal thing as well. I lost my father to pancreatic cancer when I was a medical student, and my mother is a breast cancer survivor. So, I understand from that perspective what happens and how vulnerable patients feel after a cancer diagnosis.”
Dr. Shirali tells her patients that fear about cancer is partly fear of the unknown, especially when it also involves issues with compromised kidney function. “Part of my job is to make a map of what lies ahead,” she says. “It becomes a little less fearful when we talk about how we will navigate the terrain together.”
While Dr. Shirali is primarily a clinician, she has a particular research interest in identifying risk factors for acute interstitial nephritis, an important cause of kidney failure that can be induced by immunotherapy in some patients.