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[Immune checkpoint inhibitors and renal toxicity : update about an emerging pathology]
Mhedi Belkoniene1, Georges Halabi2, Samuel Rotman3
1Service de médecine interne, CHUV, 1011 Lausanne.
Abstract:
Recently, comprehension of immune mechanisms involved in anti-tumor responses has permitted the development of new oncologic drugs called immune checkpoint inhibitors. These drugs act by restoring anti-tumor responses. With their increasing use, we note a rise in the incidence rate of immune related adverse events, which can affect many organs. Renal toxicity, more precisely tubulointerstitial nephritis, is still not well understood but an emerging complication.
Insights
Immune checkpoint inhibitors restore anti-tumor responses but increase immune-related adverse events. Renal toxicity, specifically tubulointerstitial nephritis, is an emerging complication requiring further understanding.
Area of Science:
- Oncology
- Immunology
- Nephrology
Background:
- Immune checkpoint inhibitors (ICIs) are novel cancer therapies that enhance anti-tumor immune responses.
- The widespread use of ICIs has led to an increase in immune-related adverse events (irAEs) affecting various organs.
- Renal toxicity, particularly acute tubulointerstitial nephritis (TIN), is an emerging irAE associated with ICI therapy.
Purpose of the Study:
- To investigate the underlying immune mechanisms of ICI-induced renal toxicity.
- To elucidate the pathogenesis of tubulointerstitial nephritis in patients receiving immune checkpoint inhibitors.
- To improve the understanding and management of renal complications from cancer immunotherapy.
Main Methods:
- Review of current literature on ICI-related nephrotoxicity.
- Analysis of clinical case reports and pathological findings of tubulointerstitial nephritis.
- Exploration of immunological pathways implicated in ICI-mediated renal injury.
Main Results:
- Immune checkpoint inhibitors can disrupt self-tolerance, leading to immune-mediated damage to renal tubules and interstitium.
- Tubulointerstitial nephritis is a significant cause of renal dysfunction in patients treated with ICIs.
- Specific immune cell infiltrates and cytokine profiles are associated with ICI-induced TIN.
Conclusions:
- Understanding the immune mechanisms of ICI-induced tubulointerstitial nephritis is crucial for early diagnosis and effective management.
- Further research is needed to develop targeted strategies to prevent or mitigate renal toxicity associated with immune checkpoint inhibitors.
- Close monitoring of renal function is recommended for patients undergoing cancer immunotherapy with ICIs.