Immune checkpoint inhibitors renal side effects and management

Immunotherapy. 2016 Dec;8(12):1417-1425. doi: 10.2217/imt-2016-0099.

Abstract

The choice of immunotherapy in the treatment of cancer has improved the prognosis of many patients affected by various malignancies. The high expectations foreseen with immunotherapy have led to fast approvals despite the incomplete understanding of the toxicity profiles in the different organs, including the kidneys. The high prevalence of chronic kidney disease in cancer patients complicates the issue further and requires a better knowledge of the renal safety profile to ensure an optimal safe treatment. This review summarizes the present knowledge of renal adverse events secondary to immune checkpoint inhibitors and discusses their pathophysiology, clinical presentation and adequate management. We also advocate the need for a multidisciplinary approach in patients with immune-related toxic adverse events.

Keywords: CTLA-4 inhibitor; PD-1 inhibitor; immune checkpoint inhibitor; kidney disease; nephrologist; onconephrology.

Publication types

  • Review

MeSH terms

  • Animals
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Costimulatory and Inhibitory T-Cell Receptors / antagonists & inhibitors*
  • Drug-Related Side Effects and Adverse Reactions / physiopathology*
  • Drug-Related Side Effects and Adverse Reactions / therapy
  • Humans
  • Immunotherapy / adverse effects
  • Immunotherapy / methods*
  • Interdisciplinary Communication
  • Kidney / drug effects*
  • Kidney / physiology
  • Neoplasms / complications
  • Neoplasms / immunology
  • Neoplasms / therapy*
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / physiopathology*
  • Renal Insufficiency, Chronic / therapy

Substances

  • Antineoplastic Agents
  • Costimulatory and Inhibitory T-Cell Receptors