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Immune-related Adverse Events from Immune Checkpoint Inhibitor Therapy

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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)

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