Perazella Mark A, Sprangers Ben
Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA.
Veterans Affairs Medical Center, West Haven, CT, USA.
Clin Kidney J. 2021 Mar 10;14(5):1301-1306. doi: 10.1093/ckj/sfab052. eCollection 2021 May.
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment since their introduction ∼15 years ago. However, these monoclonal antibodies are associated with immune-related adverse events that can also affect the kidney, resulting in acute kidney injury (AKI), which is most commonly due to acute tubulointerstitial nephritis (ATIN). Limited data are available on the true occurrence of ICI-associated AKI. Furthermore, evidence to guide the optimal management of ICI-associated AKI in clinical practice is lacking. In this issue, Oleas report a single-center study of patients with nonhematologic malignancies who received ICI treatment during a 14-month period, experienced AKI and underwent a kidney biopsy at the Vall d'Hebron University Hospital. Importantly, they demonstrate that only a minority of ICI-associated AKI patients was referred to the nephrology service and kidney biopsy was only performed in 6.4% of patients. Although the authors add to our knowledge about ICI-associated AKI, their article also highlights the need for the development of noninvasive diagnostic markers for ICI-associated ATIN, the establishment of treatment protocols for ICI-associated ATIN and recommendations for optimal ICI rechallenge in patients with previous ICI-associated AKI.
自约15年前引入以来，免疫检查点抑制剂（ICIs）彻底改变了癌症治疗方式。然而，这些单克隆抗体与免疫相关不良事件有关，这些事件也可能影响肾脏，导致急性肾损伤（AKI），最常见的原因是急性肾小管间质性肾炎（ATIN）。关于ICI相关AKI的实际发生率的数据有限。此外，缺乏在临床实践中指导ICI相关AKI最佳管理的证据。在本期中，奥莱亚斯报告了一项单中心研究，该研究针对在14个月期间接受ICI治疗、发生AKI并在巴塞罗那比拉医院接受肾活检的非血液系统恶性肿瘤患者。重要的是，他们表明，只有少数ICI相关AKI患者被转诊至肾内科，仅6.4%的患者进行了肾活检。尽管作者增加了我们对ICI相关AKI的了解，但他们的文章也强调了开发ICI相关ATIN的非侵入性诊断标志物、建立ICI相关ATIN的治疗方案以及为既往有ICI相关AKI的患者进行最佳ICI再激发的建议的必要性。
