Kidney Biopsy Should Be Performed to Document the Cause of Immune Checkpoint Inhibitor–Associated Acute Kidney Injury: Commentary

Perazella, Mark A.

doi:10.34067/kid.0001072019

Cited by 16 publications

(10 citation statements)

References 18 publications

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“…Median age of patients with glomerular disease following ICI use was 63 (IQR, [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] years and 75% were male ( Table 1) The vast majority of patients had ICI discontinued (88%) and nearly all received corticosteroid treatment (98%). Most patients had either complete (31%) or partial (42%) recovery from AKI.…”

Section: Aggregate Data Of Patients With Ici-associated Glomerular DImentioning

confidence: 99%

“…Another important topic that has been debated is the need for a kidney biopsy for ICIassociated kidney injuries. [63][64][65] The American Society of Clinical Oncology (ASCO) and the or higher is present]. 28,66 In the largest multi-center series by Cortazar et al, a kidney biopsy was performed in only 43% patients.…”

Section: Management Of Ici-associated Ain Includes Intravenous And/ormentioning

confidence: 99%

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A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease

Kitchlu

Jhaveri

Wadhwani

et al. 2021

Kidney International Reports

111

139

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Section: Aggregate Data Of Patients With Ici-associated Glomerular DImentioning

confidence: 99%

Section: Management Of Ici-associated Ain Includes Intravenous And/ormentioning

confidence: 99%

A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease

Kitchlu

Jhaveri

Wadhwani

et al. 2021

Kidney International Reports

111

139

View full text Add to dashboard Cite

show abstract

“…Whether or not kidney biopsy should be obtained prior to corticosteroid therapy is subject to current debate. 17 Seeking biopsy can prevent unnecessary empirical corticosteroid therapy or potentially ill-advised discontinuation of immune checkpoint inhibitors which could ultimately lead to inferior outcome. 18 However, some studies showed no clear benefit of a prior kidney biopsy in comparison to empirical corticosteroid therapy in cases with a clinical high suspicion for TIN.…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic tubulointerstitial nephritis exacerbated by immune checkpoint inhibitor

Scherer

Saba

Strebel

et al. 2021

Journal of Onco-Nephrology

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Background: With the expanding indications and thus broader use of immune checkpoint inhibitors, clinicians are faced with a new kind of immune-related adverse events. Because of their immune modulating effects, immune checkpoint inhibitors have the potential to worsen autoimmunity in general. Paraneoplastic syndromes can be caused by tumor-induced autoimmune mechanisms. The use of immune-activating substances such as checkpoint inhibitors might lead to exacerbation of paraneoplastic syndromes causing premature discontinuation of the immunotherapy. Case presentation: We report on a 64-year-old patient with metastasized renal cell carcinoma who developed acute kidney failure after cytoreductive nephrectomy. Work-up revealed a paraneoplastic syndrome that caused tubulointerstitial nephritis (TIN). Glucocorticoid therapy successfully reversed the acute kidney injury. However, adjuvant therapy with Nivolumab provoked a flare-up of the paraneoplastic syndrome on two occasions, eventually leading to a treatment discontinuation. Conclusions: Many cases of Nivolumab-induced TIN have been described lately. However, our case demonstrates therapy failure due to a flare-up of a pre-existing paraneoplastic syndrome of the renal cancer. Against this background, it can only be speculated that some of the TIN cases discussed in prior literature might also have been flare-ups of subclinical autoimmunity.

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“…The need for renal biopsy in the setting of ICP-associated nephrotoxicity is debated [ 76 ]. Arguments against [ 77 ] are based on the evidence that most AKI cases can be correctly assumed to be caused by ATIN, and that empirical steroid therapy will result in complete or incomplete recovery in most patients without the risk of kidney biopsy complications, which is marked for patients with a single kidney and for those with coagulopathy or thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Nephrotoxicity Associated with Novel Anticancer Agents (Aflibercept, Dasatinib, Nivolumab): Case Series and Nephrological Considerations

Piscitani

Sirolli

Liberato

et al. 2020

IJMS

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Cancer patients have an incidence of about 60% kidney disease development and are at elevated risk of acute renal damage. Kidney disease in these patients is frequently associated with nephrotoxicity from the ongoing oncological treatment. New anticancer therapeutic strategies, such as targeted therapies and immunotherapies, offer substantial benefits in the treatment of many neoplasms. However, their use is associated with significant nephrotoxicity, which qualitatively differs from that seen with traditional cytotoxic chemotherapy, while the underlying mechanisms are complex and still to be clearly defined. Nephrologists need to be knowledgeable about the array of such renal toxicities for effective collaboration with the oncologist in the prevention and management of kidney involvement. Renal adverse effects may range from asymptomatic proteinuria to renal failure, and their prompt identification and timely treatment is essential for optimal and safe care of the patient. In this article, after presenting clinical cases we discuss the differing renal toxicity of three novel anticancer agents (aflibercept, dasatinib, and nivolumab) and possible measures to counter it.

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Kidney Biopsy Should Be Performed to Document the Cause of Immune Checkpoint Inhibitor–Associated Acute Kidney Injury: Commentary

Cited by 16 publications

References 18 publications

A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease

A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease

Paraneoplastic tubulointerstitial nephritis exacerbated by immune checkpoint inhibitor

Nephrotoxicity Associated with Novel Anticancer Agents (Aflibercept, Dasatinib, Nivolumab): Case Series and Nephrological Considerations

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