Nephrotoxicity of Immune Checkpoint Inhibitors: Acute Kidney Injury and Beyond

Immune checkpoint inhibitors (ICIs) are novel humanized monoclonal antibodies that release the brakes on the immune system, resulting in the destruction of tumor cells. ICIs are approved for a variety of hematological and solid organ malignancies, and the list has been growing since the approval of ipilimumab in 2011. ICIs are associated with a variety of immune-related adverse events (irAEs). irAEs commonly affect the skin, the gastrointestinal (GI) tract, and the endocrine system. Acute kidney injury (AKI) due to ICIs (ICI-AKI) occurs in a minority of patients, and it is usually due to acute tubulointerstitial nephritis (ATIN). Treatment with corticosteroids is usually successful. There have been reports of electrolyte disorders due to ICIs, including hyponatremia, hypocalcemia, hypokalemia, and Fanconi syndrome. The diagnosis of electrolyte disorders requires vigilance and routine laboratory monitoring.