Brief Communication PD1-related Nephrotoxicity: Optimizing Its Clinical Management Through Histopathologic Features

Area of Science:

• Nephrology
• Immunology
• Oncology

Background:

• Immune-related nephrotoxicity (ir-N) is a rare adverse event associated with immune-checkpoint inhibitor (ICI) therapy.
• The clinical management of ir-N remains a subject of ongoing debate and research.

Purpose of the Study:

• To investigate the histological features of ir-N in patients treated with ICI.
• To evaluate the efficacy of a treatment strategy adapted from kidney transplant rejection protocols for managing ir-N.

Main Methods:

• Retrospective analysis of 501 patients treated with ICI.
• Kidney biopsy performed on 6 patients presenting with clinical signs of acute kidney injury due to ir-N.
• Histopathological examination of kidney biopsies.
• Implementation of acute allograft kidney rejection management protocols.

Main Results:

• Histology revealed acute tubule-interstitial nephritis in all biopsied patients, mimicking acute T-cell-mediated kidney transplant rejection.
• Patients treated with the adapted protocol showed rapid improvement in renal function.

Conclusions:

• Histological findings of immune-mediated acute kidney injury in ICI-treated patients can guide clinical management.
• Adapting strategies used for kidney transplant rejection may be an effective approach for managing ir-N.
• Further research is warranted to optimize ir-N management strategies.