Immune Checkpoint Inhibitor-Associated Nephrotoxicity
Omar Mamlouk1, Farhad R Danesh1,2
1Section of Nephrology, Division of Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Nephron
|May 31, 2023
Summary
Immune checkpoint inhibitor (ICI)-associated acute kidney injury (AKI) is a rare but serious complication. This review discusses ICI-AKI management and re-challenge strategies, highlighting data limitations and future research needs.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are increasingly used in cancer therapy.
- ICI-associated acute kidney injury (AKI) presents a significant clinical challenge, potentially leading to treatment cessation.
- While kidney prognosis is often favorable, re-challenging patients with ICIs after AKI remains debated.
Purpose of the Study:
- To review the mechanisms, clinical manifestations, and management of ICI-associated AKI.
- To propose a diagnostic and management strategy for ICI-AKI.
- To identify criteria for safe re-exposure to ICIs following AKI.
Main Methods:
- Comprehensive literature review of ICI-associated nephrotoxicity.
- Analysis of proposed diagnostic and management strategies.
- Discussion of clinical evidence and limitations.
Main Results:
- ICI-associated AKI can manifest in various ways and requires prompt recognition.
- A practical approach to diagnosis and management is outlined.
- Identification of patient subsets potentially eligible for ICI re-challenge after AKI is proposed.
Conclusions:
- ICI-associated AKI necessitates careful management and consideration of re-challenge protocols.
- Current evidence is largely based on retrospective studies, underscoring the need for further research.
- Key areas for future investigation include optimal immunosuppressive regimens and guidelines for restarting ICIs in patients with incomplete kidney recovery.
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