44
Treatment
Table 6. Renal Toxicities
6.1 Nephritis/Acute Kidney Injury
Grading Management
G1: Creatinine level increase of
>0.3 mg/dL; creatinine 1.5–2.0×
above baseline
• Consider temporarily holding ICPi and/or other
potential contributing agents in combination
regimens, pending consideration of potential
alternative etiologies (recent IV contrast,
medications, fluid status, UTI) and baseline
renal function. A change that is still <1.5 ULN
could be meaningful.
G2: Creatinine 2–3× above
baseline
• Hold ICPi temporarily.
• Consult nephrolog y.
• Evaluate for other causes (recent IV contrast,
medications, fluid status, etc.) If other etiologies
ruled out, administer 0.5–1 mg/kg/day
prednisone equivalents.
• If worsening or no improvement after 1
week increase to 1–2 mg/kg/day prednisone
equivalents and permanently discontinue ICPi.
• If improved to ≤G1, taper steroids over at least
4 weeks.
• If no recurrence of CRI discuss resumption of
ICPi with patient after taking into account the
risks and benefits. Resumption of ICPi can be
considered once steroids have been successfully
tapered to ≤10 mg/day or discontinued.
G3: Creatinine >3× baseline
or >4.0 mg/dL; hospitalization
indicated
• Permanently discontinue ICPi if ICPi is directly
implicated in renal toxicity.
• Consult nephrolog y.
• Evaluate for other causes (recent IV contrast,
medications, fluid status, UTI, etc.).
• Administer corticosteroids (initial dose of 1–2
mg/kg/day prednisone or equivalent).
G4: Life-threatening
consequences; dialysis indicated;
creatinine 6× above baseline
Additional considerations:
• Monitor creatinine weekly.
• Reflex kidney biopsy should be discouraged until steroid treatment has been
attempted.
(cont'd)
