Diagnosis and management of immune checkpoint inhibitor–associated nephrotoxicity: a position statement from the American Society of Onco-nephrology

Sandra M. Herrmann, Ala Abudayyeh, Shruti Gupta, Prakash Gudsoorkar, Nattawat Klomjit, Shveta S. Motwani, Sabine Karam, Verônica T. Costa E Silva, Sheikh B. Khalid, Shuchi Anand, Jaya Kala, David E. Leaf, Naoka Murakami, Arash Rashidi, Rimda Wanchoo, Abhijat Kitchlu

Research output: Contribution to journalArticlepeer-review

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer and are now the backbone of therapy for several malignancies. However, ICIs can cause a spectrum of kidney immune-related adverse events including acute kidney injury (AKI), most commonly manifesting as acute interstitial nephritis (AIN), although glomerular disease and electrolyte disturbances have also been reported. In this position statement by the American Society of Onco-nephrology (ASON), we summarize the incidence and risk factors for ICI-AKI, pathophysiological mechanisms, and clinicopathologic features of ICI-AKI. We also discuss novel diagnostic approaches and promising biomarkers for ICI-AKI. From expert panel consensus, we provide clinical practice points for the initial assessment and diagnosis of ICI-AKI, management and immunosuppressive therapy, and consideration for rechallenge with ICI following AKI episodes. In addition, we explore ICI use in special populations, such as kidney transplant recipients, and propose key areas of focus for future research and clinical investigation.

Original languageEnglish
Pages (from-to)21-32
Number of pages12
JournalKidney International
Volume107
Issue number1
DOIs
StatePublished - Jan 2025

Keywords

  • acute interstitial nephritis
  • acute kidney injury
  • immune checkpoint inhibitors
  • immune-related adverse event

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