Immune Checkpoint Inhibitor–Associated AKI: Debates in Diagnosis, Management, and Rechallenge

Seethapathy, Harish; Herrmann, Sandra M.; Rashidi, Arash

doi:10.1016/j.semnephrol.2023.151346

Cited by 3 publications

(3 citation statements)

References 57 publications

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“…In our study, ICI-AKI recurred in only 1 of 14 patients who underwent rechallenge. Although the data are limited, together with the findings of other studies, we found a low recurrence rate of ICI-AKI [ 12 , 13 , 39 ]. Therefore, we believe that rechallenge with ICIs can be considered after detailed evaluation in patients for whom ICIs are the best antitumor treatment.…”

Section: Discussioncontrasting

confidence: 75%

“…However, previous reports have shown that the major histopathological type of renal biopsy sample is acute tubulointerstitial nephritis (ATIN) [ 13 , 26 , 31 , 40 ]. Many studies have identified biomarkers of ICI-AKI, including serum C-reactive protein (CRP), IL-17, tumor necrosis factor-α, the urine retinol binding protein-to-creatinine ratio, and urine sCD163 [ 7 , 26 , 38 , 39 ]. However, their use in the diagnosis of ICI-AKI needs to be further confirmed by additional studies.…”

Section: Discussionmentioning

confidence: 99%

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Acute kidney injury in patients treated with immune checkpoint inhibitors: a single-center retrospective study

Zhou,

Liu,

Shen

et al. 2024

Renal Failure

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Background Immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI) is the most common renal complication and has attracted increasing amounts of attention. However, studies on this topic in Chinese cancer patients are very limited. Therefore, we conducted a retrospective study on the incidence, risk factors, clinical features and renal recovery of ICI-AKI in all patients with malignancies treated with ICIs in Shandong Provincial Hospital Affiliated to Shandong First Medical University. Methods In this single-center retrospective cohort study, the data of 904 patients who received immune checkpoint inhibitors (ICIs) treatment were retrospectively analyzed. Multivariable logistic regression was used to identify the predictors of ICI-AKI. Results A total of 46 of 904 patients receiving ICIs developed ICI-AKI, and the incidence of ICI-AKI was 5.1%. Patients developed ICI-AKI at a median of 9 weeks (IQR 3–23) after ICIs initiation. A lower baseline estimated glomerular filtration rate (eGFR) and use of antibiotics were associated with a higher risk of ICI-AKI. Renal recovery occurred in 17 patients (46%) at a median of 4 weeks (IQR 2–8) after ICI-AKI, including 16 (43%) with complete recovery and 1 (3%) with partial recovery. Of the 14 rechallenged patients, only one developed recurrent ICI-AKI. Conclusions Patients with ICI-AKI were more likely to have impaired renal function at baseline and after treatment with antibiotics. Approximately half of the patients achieved renal recovery.

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in patients treated with immune checkpoint inhibitors: a single-center retrospective study

Zhou,

Liu,

Shen

et al. 2024

Renal Failure

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“…[48][49][50] Discontinuation of ICIs and administration of corticosteroids in acute tubulointerstitial nephritis are recommended for first-line therapy. 13,51,52 Nevertheless, according to recent research, prednisone in high doses (1 mg/kg at least) should only be used until baseline kidney function restoration or for a maximum of three weeks before a 5-to 6-week tapering period. 53 Furthermore, a retrospective study found that the risk of recurrence and recovery of kidney function was comparable for patients with ICI-associated AKI receiving corticosteroids for shorter periods (28 days or less) compared to longer periods.…”

Section: Management Of Nephrotoxicitymentioning

confidence: 99%

The Nephrotoxicity of Checkpoint Inhibitors: A Mini Review

Mahmoodpoor,

Ardalan,

Nasibova

et al. 2024

Int J Drug Res Clin

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Immune checkpoint inhibitors (ICIs) have established promising therapeutic outcomes in the treatment of more than 17 tumors and are being used more frequently. Although these drugs have made progress in cancer treatment over the past ten years, severe immune-related adverse events (irAEs) can be fatal. Nephrotoxicity is less frequent than toxicities that affect the gastrointestinal tract, the skin, and the endocrine system, yet it is frequently underdiagnosed because of its difficulty. The most frequent nephrotoxicity is acute kidney injury (AKI), which is typically linked to acute interstitial nephritis. It is possible for kidney impairment caused by ICIs to manifest in much more varied ways, which may have an impact on the management strategies for therapeutic as well as diagnostic purposes. The current study discussed the most recent ICIs for cancer that have been approved, the risk factors and prevalence of nephrotoxicity, the present knowledge of the pathological mechanisms of AKI, and the management protocols.

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Pharmacotherapy considerations in patients who develop acute kidney injury during anti-cancer therapy

Parodi,

Rossi,

Bottiglieri

et al. 2024

Expert Opinion on Pharmacotherapy

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Immune Checkpoint Inhibitor–Associated AKI: Debates in Diagnosis, Management, and Rechallenge

Cited by 3 publications

References 57 publications

Acute kidney injury in patients treated with immune checkpoint inhibitors: a single-center retrospective study

Acute kidney injury in patients treated with immune checkpoint inhibitors: a single-center retrospective study

The Nephrotoxicity of Checkpoint Inhibitors: A Mini Review

Pharmacotherapy considerations in patients who develop acute kidney injury during anti-cancer therapy

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