Immune checkpoint inhibitors and renal toxicity

Area of Science:

• Oncology
• Nephrology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, offering improved survival for various malignancies.
• ICIs function by targeting immune-regulatory receptors to enhance anti-tumor immune responses.
• Despite efficacy, ICIs are associated with immune-related adverse effects (irAEs), including renal toxicity.

Purpose of the Study:

• To review the pathophysiology, clinical presentation, and histological features of renal toxicity induced by ICIs.
• To specifically address the challenges and management strategies for kidney transplant (KT) recipients undergoing ICI therapy.
• To discuss therapeutic adaptations in immunosuppression and the risk of rejection in KT patients on ICIs.

Main Methods:

• Literature review and synthesis of existing research on ICI-induced nephrotoxicity.
• Analysis of clinical case studies and histological findings related to ICI renal adverse events.
• Focus on specific considerations for kidney transplant recipients, including immunosuppression protocols.

Main Results:

• ICI-associated renal toxicity presents with diverse clinical and histological patterns.
• Management of irAEs requires careful diagnostic and therapeutic approaches, often involving multidisciplinary teams.
• Kidney transplant recipients face unique challenges, including potential rejection and the need for modified immunosuppression.

Conclusions:

• Understanding ICI renal toxicity is crucial for optimizing cancer treatment and patient outcomes.
• Specialized management protocols are necessary for kidney transplant recipients receiving ICIs to balance anti-cancer efficacy with graft survival.
• Further research is needed to refine diagnostic and therapeutic strategies for ICI-induced nephrotoxicity, particularly in vulnerable populations like KT recipients.