Immune checkpoint inhibitors in patients with chronic kidney disease: Assessing their ability to cause acute kidney injury and informing their proper use

Ji Won Min; Jeong Uk Lim

doi:10.1053/j.seminoncol.2022.01.012

Immune checkpoint inhibitors in patients with chronic kidney disease: Assessing their ability to cause acute kidney injury and informing their proper use

Semin Oncol. 2022 Apr;49(2):141-147. doi: 10.1053/j.seminoncol.2022.01.012. Epub 2022 Feb 15.

Authors

Ji Won Min¹, Jeong Uk Lim²

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
² Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: cracovian@catholic.ac.kr.

PMID: 35264308
DOI: 10.1053/j.seminoncol.2022.01.012

Abstract

Immune check point inhibitors (ICI) have secured regulatory approvals across the world for the treatment of various types of cancers. Though not as frequent as immune-related adverse events (AEs) involving other organs, a considerable number of ICI-related renal AE have also been reported and predicting such events has become important. We provide an updated review on possible mechanisms of ICI-related acute kidney injury (AKI), related risk factors, and the use of ICIs in patients with chronic kidney diseases (CKD). A systematic search for related articles was conducted. Acute tubulointerstitial nephritis (ATIN) is known to be the main cause of ICI-related AKI, with glomerulonephritis also a significant cause. Factors including use of concurrent medications, extra-renal immune related AEs, and combination of two or more immunotherapy drugs are possible risk factors. Use of ICI in patients with CKD may be related to increased occurrence of overall immune related AEs. If the diagnosis of ICI related renal AEs is confirmed, prompt use of steroids is recommended, and in severe cases of AKI, discontinuation of ICI should be considered.

Keywords: Acute kidney injury; Acute tubulointerstitial nephritis; Immune checkpoint inhibitor; Kidney; Renal.

Publication types

Review

MeSH terms

Acute Kidney Injury* / chemically induced
Acute Kidney Injury* / diagnosis
Acute Kidney Injury* / drug therapy
Humans
Immune Checkpoint Inhibitors / adverse effects
Neoplasms* / drug therapy
Nephritis, Interstitial* / chemically induced
Nephritis, Interstitial* / diagnosis
Nephritis, Interstitial* / drug therapy
Renal Insufficiency, Chronic* / chemically induced
Renal Insufficiency, Chronic* / drug therapy

Substances

Immune Checkpoint Inhibitors