Diagnosis and management of immune checkpoint inhibitor-associated acute kidney injury
Immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI) occurs in roughly 2-5% of treated patients, most often manifesting as acute tubulointerstitial nephritis, and generally responds favorably to early corticosteroids with complete or partial recovery in most patients.
Background
Immune checkpoint inhibitors have transformed cancer treatment but cause immune-related adverse events that can affect virtually any organ, including the kidneys. ICI-AKI can force temporary or permanent discontinuation of ICIs or concomitant anticancer therapy and may require prolonged corticosteroid treatment. Proposed mechanisms include loss of tolerance to self-antigens, reactivation of drug-specific effector T cells, and production of kidney-specific autoantibodies.
Key recommendations
Evaluation of suspected ICI-AKI requires a careful diagnostic work-up to exclude alternative causes, with kidney biopsy recommended for patients with moderate-to-severe ICI-AKI to confirm the diagnosis and guide treatment. ICI-AKI most commonly manifests as acute tubulo-interstitial nephritis on biopsy, and early initiation of corticosteroids is the mainstay of management.
Clinical implications
ICI-AKI generally shows a favorable response to early corticosteroids, with complete or partial remission achieved in most patients. Accurate diagnosis and prompt treatment are essential to preserve kidney function and inform decisions about continuing or rechallenging with checkpoint inhibitor therapy.
Category
Research
Source
Nature Reviews Nephrology
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