Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports

Frontiers in Oncology

Oncology

Michela Piaggio¹  Elvina Lecini¹  Lucia Macciò¹  Annarita Bottini¹  Carlo Genova²  Francesca Cappadona³  Pasquale Esposito⁴  Francesca Viazzi⁴ 

[1] Department of Internal Medicine, University of Genova, Genova, Italy;Department of Internal Medicine, University of Genova, Genova, Italy;UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy;Nephrology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy;Nephrology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy;Department of Internal Medicine, University of Genova, Genova, Italy;

关键词: immune checkpoint inhibitors;    cancer;    acute kidney injury;    acute tubulointerstitial nephritis;    pooled analysis;    corticosteroids;    renal biopsy;    chronic kidney disease;   

DOI  :  10.3389/fonc.2023.1221135

 received in 2023-05-11, accepted in 2023-10-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionAcute kidney injury (AKI) in cancer patients receiving immune checkpoint inhibitors (ICIs) may recognize multiple causes. Here, we reviewed cases of biopsy-proven acute tubulointerstitial nephritis (ATIN) to describe the clinical characteristics and outcomes of this condition.MethodWe conducted a pooled analysis of clinical cases of ICI-related biopsy-proven ATIN up to 1 May 2022. We collected data on clinical characteristics, AKI, biopsy findings, laboratory examinations, and renal outcomes.ResultsEighty-five patients (61.4 ± 19 years, 56 male) were evaluated. Melanoma was the most prevalent diagnosis (51%), followed by non-small cell lung cancer (30%). ICI treatment consisted of PD-1, PDL-1 (nivolumab, pembrolizumab, atezolizumab), and CTLA-4 inhibitors (i) (ipilimumab) or combination PD-1i+CTLA4i. Renal toxicity developed after a median of four cycles of therapy. Fifty-one patients (65.5%) developed the most severe form of AKI- stage 3, including five patients requiring dialysis. All the 19 patients treated with dual ICI blockade developed AKI-stage 3, compared with 29 patients out of the 60 receiving a single agent (p<0.001). Most events were managed with corticosteroids associated with ICI withdrawal. In 15 patients ICI was restarted, but in six (40%) AKI recurred. Overall, 32 patients (40%) presented a complete renal recovery, which chance was inversely associated with dual ICI blockade (OR 0.15, 95CI 0.03-0.7, p=0.01).ConclusionICI-related ATIN may develop late after the therapy initiation, presenting as severe AKI, particularly in patients with dual ICI blockade. Although this complication may be partially reversible, concerns remain about the renal function sequelae and the possibility of restarting ICI treatment.

【 授权许可】

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Copyright © 2023 Esposito, Bottini, Lecini, Cappadona, Piaggio, Macciò, Genova and Viazzi