A systematic review of immune checkpoint inhibitor–associated glomerular disease
A systematic review of biopsy-proven immune checkpoint inhibitor-associated glomerular disease found that pauci-immune glomerulonephritis/vasculitis, podocytopathies, and C3 glomerulonephritis are the most common lesions, and these glomerular injuries may carry poor kidney and mortality outcomes.
Background
Immune checkpoint inhibitors are increasingly used in oncology, and kidney immune-related adverse events are now well recognized, with reported incidence around 2% to 5%. Most prior data focused on acute interstitial nephritis, with limited information on the types, frequencies, treatment, and outcomes of glomerular disease associated with these agents.
Key recommendations
The authors performed a systematic review and meta-analysis of all biopsy-proven published cases and series of checkpoint inhibitor-associated glomerular pathology, searching MEDLINE, EMBASE, and Cochrane databases from inception to February 2020. After screening, 27 articles describing 45 cases of biopsy-confirmed glomerular disease were identified, and patient-level data on demographics, cancer and therapy details, and kidney injury characteristics were abstracted.
Clinical implications
The most frequent lesions were pauci-immune glomerulonephritis and renal vasculitis (27%), podocytopathies (24%), and C3 glomerulonephritis (11%), with concomitant acute interstitial nephritis in 41% of cases. Most patients had the checkpoint inhibitor discontinued (88%) and nearly all received corticosteroids (98%); renal replacement therapy was required in 25%, about one-third died, and full or partial recovery from acute kidney injury occurred in 31% and 42% respectively. The review concludes that oncologists and nephrologists should be aware of these glomerular pathologies and consider kidney biopsy when features atypical for interstitial nephritis are present.
Category
Research
Source
Kidney International Reports
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