45
Table 6. Renal Toxicities
6.2 Nephritis/Acute Kidney Injury — Follow Up
Grading Management
G1: Creatinine level increase of
>0.3 mg/dL; creatinine 1.5–2.0×
above baseline
If improved to baseline:
• Resume routine creatinine monitoring.
G2: Creatinine 2–3× above
baseline
If improved to Grade 1:
• Taper corticosteroids over at least 4 weeks before
resuming treatment with routine creatinine
monitoring.
• If elevations persist >7 days or worsen and no
other cause found, treat as Grade 3.
G3: Creatinine >3× baseline
or >4.0 mg/dL; hospitalization
indicated
If improved to Grade 1:
• Taper corticosteroids over at least 4 weeks.
• If elevations persist >3–5 days or worsen,
consider additional immunosuppression (e.g.,
infliximab, azathioprine, cyclophosphamide
(monthly), cyclosporine, mycophenolate).
G4: Life-threatening
consequences; dialysis indicated;
creatinine 6× above baseline
If improved to Grade 1:
• Taper corticosteroids over at least 4 weeks.
• If elevations persist >2–3 days or worsen,
consider additional immunosuppression (e.g.,
infliximab, azathioprine, cyclophosphamide
(monthly), cyclosporine, mycophenolate).
(cont'd)
