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

doi:10.1016/j.kint.2024.09.017

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

Kidney Int. 2025 Jan;107(1):21-32. doi: 10.1016/j.kint.2024.09.017. Epub 2024 Oct 24.

Authors

Sandra M Herrmann¹, Ala Abudayyeh², Shruti Gupta³, Prakash Gudsoorkar⁴, Nattawat Klomjit⁵, Shveta S Motwani⁶, Sabine Karam⁷, Verônica T Costa E Silva⁸, Sheikh B Khalid⁹, Shuchi Anand¹⁰, Jaya Kala¹¹, David E Leaf⁹, Naoka Murakami⁹, Arash Rashidi¹², Rimda Wanchoo¹³, Abhijat Kitchlu¹⁴

Affiliations

¹ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: [email protected].
² Section of Nephrology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
³ Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Medical Oncology, Dana-Farber Cancer Institute. Harvard Medical School, Boston, Massachusetts, USA.
⁴ Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, USA.
⁵ Department of Medicine, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA.
⁶ Department of Medical Oncology, Dana-Farber Cancer Institute. Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Medicine, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA; Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon.
⁸ Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Laboratório de Investigação Médica (LIM) 16, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁹ Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
¹⁰ Department of Medicine (Nephrology), Stanford University, Stanford, California, USA.
¹¹ Division of Renal Diseases and Hypertension, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas, USA.
¹² Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
¹³ Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York, USA.
¹⁴ Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.

PMID: 39455026
DOI: 10.1016/j.kint.2024.09.017

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.

Keywords: acute interstitial nephritis; acute kidney injury; immune checkpoint inhibitors; immune-related adverse event.

Publication types

Consensus Development Conference

MeSH terms

Acute Kidney Injury* / chemically induced
Acute Kidney Injury* / diagnosis
Acute Kidney Injury* / immunology
Acute Kidney Injury* / therapy
Biomarkers / blood
Consensus
Humans
Immune Checkpoint Inhibitors* / adverse effects
Immunosuppressive Agents / adverse effects
Incidence
Kidney Transplantation
Neoplasms / drug therapy
Nephritis, Interstitial / chemically induced
Nephritis, Interstitial / diagnosis
Nephritis, Interstitial / immunology
Nephritis, Interstitial / therapy
Nephrology / methods
Nephrology / standards
Risk Factors
Societies, Medical / standards
United States / epidemiology

Substances

Biomarkers
Immune Checkpoint Inhibitors
Immunosuppressive Agents