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Immune Checkpoint Inhibitor-Associated Acute Kidney Injury: A Report from the 34th Acute Disease Quality Initiative
Shruti Gupta1,2,3, Roberta Fenoglio4, Naoka Murakami5
1Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA.
Journal of the American Society of Nephrology : JASN
|July 31, 2026
Summary
Immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI) is a significant concern in cancer therapy. Early glucocorticoid treatment may improve kidney recovery, and cautious rechallenge is possible for select patients.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment.
- However, ICIs can cause immune-related adverse events, including ICI-associated acute kidney injury (ICI-AKI).
- ICI-AKI poses diagnostic and management challenges, impacting patient outcomes.
Purpose of the Study:
- To establish consensus statements on the diagnosis and management of ICI-AKI.
- To provide guidance on ICI rechallenge in patients with ICI-AKI.
- To identify future research priorities for ICI-AKI.
Main Methods:
- An international, multidisciplinary panel convened at the 34th Acute Disease Quality Initiative (ADQI) consensus conference.
- Systematic literature searches of PubMed were performed.
- A modified Delphi method was used to achieve consensus on evidence-based statements.
Main Results:
- AKI affects up to 20% of patients on ICIs; ICI-AKI accounts for 2-5% of cases.
- Acute tubulointerstitial nephritis is the most common biopsy finding (80-90%).
- Early glucocorticoid initiation (within 3 days) is linked to better kidney recovery.
Conclusions:
- Kidney biopsy remains the gold standard for diagnosing ICI-AKI.
- Early glucocorticoid treatment may improve kidney outcomes.
- Cautious ICI rechallenge is feasible in selected patients, with recurrence rates under 20%.
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