Immune Checkpoint Inhibitors and Kidney Toxicity: Advances in Diagnosis and Management

Abstract

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Nivolumab-induced acute tubular injury: a case report

“…For persistent grade 2 (doubling of Cr or higher), the guidelines recommend discontinuing ICIs. They also recommend a corticosteroid taper that begins when Cr improves to grade 1 or below 2 . The guidelines from the National Comprehensive Cancer Network specify a starting dose and duration for the corticosteroid taper: 0.5-1 mg/kg/day for grade 2 and 1-2 mg/kg/day for grade 3 AKI with the dose being tapered over 4-6 weeks after Cr decreases to less than or equal to grade 1 2,21 .…”

“…They also recommend a corticosteroid taper that begins when Cr improves to grade 1 or below 2 . The guidelines from the National Comprehensive Cancer Network specify a starting dose and duration for the corticosteroid taper: 0.5-1 mg/kg/day for grade 2 and 1-2 mg/kg/day for grade 3 AKI with the dose being tapered over 4-6 weeks after Cr decreases to less than or equal to grade 1 2,21 . In the scenario of ICI-induced AKI, there are currently no rechallenge guidelines to come after.…”

Immune checkpoint inhibitor related nephrotoxicity: Advances in clinicopathologic features, noninvasive approaches, and therapeutic strategy and rechallenge

“…However, combination of the CTLA-4 inhibitor ipilimumab and the PD-1 inhibitor nivolumab carries a higher risk of ICI-related AKI (4.9%) than monotherapy with either ipilimumab (2%), nivolumab (1.9%), or pembrolizumab (1.4%) (28). Data from some clinical trials also shows less organ-toxicity such as pneumonitis and colitis in patients receiving PD-L1 inhibitors than PD-1 and CTLA-4 inhibitors (6,31,32). However, post-marketing surveillance data indicate that atezolizumab may have the highest risk of kidney side effects among all ICI monotherapies but confirm a low risk of ICIrelated AKI with avelumab (33).…”

Onconephrology 2022: An Update

“…However, many immune-related adverse events have been described with these medications 1 , including ICI associated AKI. Most kidney immune-related adverse events are due to acute interstitial nephritis (AIN) 2 .…”