Clinical recommendations on diagnosis and treatment of immune checkpoint inhibitor-induced renal immune-related adverse events.

Ke Zheng,Xiaotong Zhang,Li Zhang,Xiaoyan Si,Wei Qiu,Xuemei Li,Hanping Wang

doi:10.1111/1759-7714.13405

Abstract

Immune checkpoint inhibitors (ICIs) are nowadays widely used in clinical oncology treatment, and significantly improve the prognosis of cancer patients. However, overactivation of T cells and related signaling pathways caused by ICIs can also induce immune‐related adverse effects (irAEs). Renal immune side‐effects are relatively rare, but some are serious and fatal. Acute kidney injury (AKI), diagnosed mainly by percentage increases in serum creatinine (sCr), is the most common clinical manifestation, while acute tubulointerstitial nephritis (ATIN) is the main cause of ICI‐related AKI. Urinalysis analysis and sediment evaluation, 24 hour urine protein and sCr are helpful in screening and monitoring renal irAEs. Multiple potential causes for AKI are involved during cancer therapy, and should be differentiated from the immune mechanisms of ICIs. Under these circumstances, a renal biopsy should be considered which is essential for clinical decision‐making. Steroids are an effective treatment option for renal irAEs. Most patients who experience ICI‐related ATIN achieve a partial or complete renal recovery with prompt diagnosis and treatment. Multidisciplinary collaborations of different specialists will improve the effectiveness and outcome in the management of ICI irAEs.

Highlights

In recent years, studies on immune checkpoint inhibitors (ICIs) have greatly accelerated the development of oncology treatment
In addition to the above mechanism of ICI immune-related adverse effects (irAEs), it is thought that ICIs can reactivate previously silenced drug-specific T cells primed by nephritogenic drugs associated with acute tubulointerstitial nephritis (ATIN), and activate relative memory T cells against the drug.[3]
In the meantime, immunerelated adverse events caused by overactivity of T cells in ICI treatment should receive more attention

Summary

Introduction

Studies on immune checkpoint inhibitors (ICIs) have greatly accelerated the development of oncology treatment. To date, based on limited data of kidney biopsies in patients received ICIs, it is difficult to determine the accurate incidence of ICI-related ATIN.

Results

Conclusion