2.4 COVID-9 infection and renal cancer

Cancer patients undergoing cancer chemotherapy are among those likely to be easily infected with SARS-CoV-2 due to drug-related immunosuppression (Ofori-Asenso et al., 2020; Mihalopoulos et al., 2020). Globally, renal cell carcinoma (RCC) represents the 6th and 10th most diagnosed cancer in men and women, and accounts for 5% and 3% of all cancers in males and females respectively (Wallis et al., 2020). A recent study revealed predominant expression of coronavirus receptors (CoV; DPP4, ANPEP, ENPEP) in clear cell RCC and also in other forms of renal cancers such as papillary and chromophobe subtypes (Tripathi et al., 2020). This finding confirms increased risk of SARS-CoV-2 infection in these groups of patients. Hence, a number of strategies have been proposed and employed to provide care for these patients in this COVID-19 era, including postponing chemotherapy, minimizing elective surgical procedures in patients with stable cancer as well as in those patients at high risk for ending up in the intensive care units following surgery (Al-Quteimat and Amer, 2020). In the light of these strategies, recommendations for the deferment for cytoreductive nephrectomy in patients with metastatic RCC in this COVID-19 era and replacement with systemic therapy for patients with intermediate to poor-risk disease has been made (Ged et al., 2020). Current data from a study gives both medical practitioners and patients some hope, as surgery can be safely delayed in a subgroup of patients with RCC to between 3 and 6 months without significant sacrifice in overall survival (Srivastava et al., 2021). Overall, patients with RCC and other forms of renal cancer, who are undergoing cancer chemotherapy are at a higher risk of COVID-19 infection, which could further exacerbate their kidney condition.