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The role of kidney biopsy in immune checkpoint inhibitor nephrotoxicity

Emily M Moss1, Mark A Perazella2,3

  • 1Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States.

Frontiers in Medicine
|August 29, 2022
PubMed

Insights

Immune checkpoint inhibitors (ICIs) can cause kidney damage (nephrotoxicity), a serious side effect in cancer patients. This review covers diagnosing and managing ICI-induced kidney injury, emphasizing kidney biopsy

Area of Science:

  • Oncology
  • Nephrology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are revolutionary cancer therapies that enhance the host immune response against tumor cells.
  • While effective, ICIs can induce significant autoimmune side effects, affecting various organs, including the kidneys.
  • Immune checkpoint inhibitor nephrotoxicity is a growing cause of acute kidney injury in cancer patients undergoing immunotherapy.

Purpose of the Study:

  • To review the clinical and histopathologic diagnostic approaches for immune checkpoint inhibitor nephrotoxicity.
  • To discuss the current controversies and indications for kidney biopsy in diagnosing and managing ICI-induced kidney injury.
  • To outline treatment strategies and the considerations for re-challenging patients with immunotherapy after experiencing nephrotoxicity.

Main Methods:

  • Comprehensive literature review focusing on clinical presentation, histopathology, diagnostic modalities, and management of immune checkpoint inhibitor nephrotoxicity.
  • Analysis of current evidence regarding the role and limitations of kidney biopsy in the context of suspected ICI-induced kidney injury.
  • Discussion of therapeutic interventions and decision-making processes for immunotherapy re-challenge.

Main Results:

  • Immune checkpoint inhibitor nephrotoxicity presents with diverse clinical and histopathologic findings, often mimicking other causes of acute kidney injury.
  • There is a recognized need for improved non-invasive diagnostic tools to detect and monitor ICI-induced kidney damage.
  • Kidney biopsy remains a valuable diagnostic tool in specific circumstances, despite ongoing debate regarding its routine use.

Conclusions:

  • Accurate diagnosis of immune checkpoint inhibitor nephrotoxicity is crucial for appropriate management and patient outcomes.
  • Further research into non-invasive biomarkers is warranted to enhance diagnostic capabilities.
  • A judicious approach to kidney biopsy and careful consideration of immunotherapy re-challenge are essential in managing these adverse events.
Keywords:
acute kidney injurydrug induced kidney injuryimmune checkpoint inhibitorinterstitial nephritiskidney biopsy

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