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Renal complications of immune checkpoint blockade

Naoka Murakami1, Shveta Motwani2, Leonardo V Riella1

  • 1Schuster Family Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts; Renal Division, Brigham and Women's Hospital, Boston, Massachusetts.

Current Problems in Cancer
|February 13, 2017
PubMed

Insights

Immune checkpoint inhibitors can cause rare kidney problems. This review covers how to identify, manage, and prevent these immune-related adverse events (irAE), including in patients with existing kidney disease.

Area of Science:

  • Oncology
  • Nephrology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are increasingly used for various cancers.
  • Renal immune-related adverse events (irAEs) are uncommon but significant complications of ICIs.
  • Early recognition and management of renal irAEs are crucial for patient outcomes.

Purpose of the Study:

  • To provide a comprehensive review of renal irAEs associated with ICIs.
  • To summarize current knowledge on clinical presentation, pathology, and management strategies.
  • To discuss ICI safety in patients with pre-existing chronic kidney disease and kidney transplant recipients.

Main Methods:

  • Literature review of clinical studies and case reports on renal irAEs.
  • Analysis of data on incidence, clinical features, and histopathology.
  • Synthesis of current guidelines and expert opinions on management.

Main Results:

  • Renal irAEs manifest in diverse clinical and pathological patterns.
  • Prompt diagnosis and appropriate immunosuppressive therapy can lead to favorable outcomes.
  • Specific considerations are necessary for managing patients with chronic kidney disease and transplant recipients.

Conclusions:

  • Renal irAEs are a manageable toxicity of ICIs.
  • Physicians must be vigilant in monitoring for and treating renal complications.
  • Further research is needed to optimize ICI use in vulnerable kidney populations.
Keywords:
CTLA-4Immune check point inhibitorPD-1acute kidney injurychronic kidney injurytransplant

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