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Diagnosis and treatment of immune checkpoint inhibitor induced kidney disease

Kavita Mistry1,2, Roya Best2, Christopher T Stueber2

  • 1Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School.

Current Opinion in Nephrology and Hypertension
|July 19, 2026
PubMed
Abstract

Insights

New urinary biomarkers like CXCL9 and TNF-α show promise for diagnosing immune checkpoint inhibitor-induced acute interstitial nephritis (ICI-AIN). Treatment strategies using infliximab and shorter corticosteroid courses may preserve anti-cancer effects.

Area of Science:

  • Oncology
  • Nephrology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are increasingly used for cancer treatment.
  • ICI therapy can cause kidney inflammation, specifically acute interstitial nephritis (AIN), in 3-5% of patients.
  • Accurate, noninvasive diagnostic tools and targeted therapies for ICI-AIN are needed.

Purpose of the Study:

  • To review emerging noninvasive diagnostic strategies for ICI-AIN.
  • To discuss potential therapeutic approaches for ICI-AIN that preserve anti-tumor efficacy.
  • To inform nephrologists about advances in ICI-AIN management.

Main Methods:

  • Review of recent literature on ICI-induced kidney inflammation.
  • Analysis of novel urinary biomarkers for AIN diagnosis.
  • Evaluation of therapeutic strategies for ICI-AIN.

Main Results:

  • Urinary biomarkers such as C-X-C motif ligand 9 (CXCL9), tumor necrosis factor alpha (TNF-α), interleukin 5 (IL-5), and Fas show diagnostic potential.
  • Infliximab and shorter corticosteroid courses are emerging treatment options for ICI-AIN.
  • These treatments may help preserve the anti-tumor effects of ICIs.

Conclusions:

  • Novel biomarkers require further validation but show promise for diagnosing ICI-AIN.
  • Understanding ICI-AIN immunobiology may lead to more targeted therapies, such as those targeting TNF-α.
  • Nephrologists must stay informed about biomarker advancements and new immunosuppressive treatments for ICI-AIN.
Keywords:
C-X-C motif ligand 9biomarkerimmune checkpoint inhibitorinterstitial nephritisonconephrology

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