Journal
KIDNEY360
Volume 1, Issue 2, Pages 130-140Publisher
AMER SOC NEPHROLOGY
DOI: 10.34067/KID.0000852019
Keywords
Clinical Nephrology; Acute Kidney Injury and ICU Nephrology; Nephro-Pharmacology; acute interstitial nephritis; Acute kidney injury; acute tubulointerstitial nephritis; immune-related adverse event; immunotherapy
Categories
Funding
- National Institute on Deafness and Other Communication Disorders [F32DC017342]
- National Institute of Diabetes and Digestive and Kidney Diseases [K23DK106448]
- National Heart, Lung, and Blood Institute [R01HL144566]
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases [R01AI143887]
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Immune checkpoint inhibitors (ICPIs) have transformed the landscape of oncology, but are associated with a variety of autoimmune adverse events, including AKI. ICPI-associated AKI (ICPI-AKI) is emerging as an increasingly frequent cause of AKI in patients with cancer, and poses unique diagnostic and management challenges to clinicians who care for these patients. In this review, we describe the incidence and risk factors for ICPI-AKI, including proton pump inhibitor use, CKD, and combination immunotherapy. We discuss the limitations of the various definitions used for ICPI-AKI in prior studies, and propose a novel classification system (definite, probable, and possible ICPI-AKI) that recognizes the diagnostic uncertainty inherent in many cases. We discuss the key clinicopathologic features and treatment strategies for ICPI-AKI, including the role of kidney biopsy versus empirical treatment with steroids. We also explore the under-studied area of ICPI use in the setting of solid organ transplantation, where nephrologists and oncologists must balance the risk of rejection versus treating the underlying malignancy. Finally, we summarize existing data on the role of ICPI rechallenge after an episode of ICPI-AKI.
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