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Table 6. Renal Toxicities
Nephritis and Renal Dysfunction — Diagnosis and Monitoring
Clinical Presentation* and Diagnosis:
Definite ICPi-RELATED nephritis/acute kidney injury (AKI):
• Kidney biopsy-confirmed diagnosis compatible with ICPi-Nephritis/AKI, and after
clinical review of risk factors.
†
Probable ICPi-RELATED nephritis/acute renal failure:
BOTH of the following:
• Sustained increase in serum creatinine ≥50% on at least two consecutive values or
need for renal replacement therapy (RRT), after clinical review of risk factors.
†
• Absence of an alternative plausible etiolog y.
AND at least one of the following:
• Sterile pyuria (≥5 WBCs/hpf )
• Concomitant or recent extrarenal irAE-eosinophilia (≥500 cells per µL)
Possible ICPi-RELATED Nephritis/Acute Renal Failure:
BOTH of the following:
• Increase in serum creatinine ≥50%
• Need for RRT nephritis/AKI is not readily attributable to alternative causes
* Adapted from Gupta, 2020.
†
Risk factors include prior or concomitant nephrotoxic agent(s) use, prior or concomitant
extrarenal irAEs.
Monitoring
• Monitor patients for elevated serum creatinine prior to every dose.
• Routine urinalysis is not necessary, other than to rule out urinary tract infections
(UTIs), etc.
• For any suspected immune-mediated adverse reactions, exclude other causes (see below).
• For suspected renal irAE obtain urinalysis, consider referral to nephrolog y.
• For patients receiving combination therapy with immune checkpoint inhibitors and
other agents, assess the potential contribution of the non-iCPI treatment to the renal
failure.
• Assess for concomitant medications, prescribed and OTC, herbals, vitamins,
nephrotoxic agents, or contrast media.
• If no potential alternative cause of AKI identified, then one can assume it is ICPi
related and should forego biopsy.
• Swift treatment of autoimmune component is important.
