Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Semin Oncol. 2022 Apr;49(2):141-147. doi: 10.1053/j.seminoncol.2022.01.012. Epub 2022 Feb 15.
Immune check point inhibitors (ICI) have secured regulatory approvals across the world for the treatment of various types of cancers. Though not as frequent as immune-related adverse events (AEs) involving other organs, a considerable number of ICI-related renal AE have also been reported and predicting such events has become important. We provide an updated review on possible mechanisms of ICI-related acute kidney injury (AKI), related risk factors, and the use of ICIs in patients with chronic kidney diseases (CKD). A systematic search for related articles was conducted. Acute tubulointerstitial nephritis (ATIN) is known to be the main cause of ICI-related AKI, with glomerulonephritis also a significant cause. Factors including use of concurrent medications, extra-renal immune related AEs, and combination of two or more immunotherapy drugs are possible risk factors. Use of ICI in patients with CKD may be related to increased occurrence of overall immune related AEs. If the diagnosis of ICI related renal AEs is confirmed, prompt use of steroids is recommended, and in severe cases of AKI, discontinuation of ICI should be considered.
免疫检查点抑制剂（ICI）已在全球范围内获得批准，用于治疗各种类型的癌症。尽管 ICI 相关的肾脏不良反应（AE）不如涉及其他器官的免疫相关不良反应那么常见，但也有相当数量的 ICI 相关肾脏 AE 被报道，因此预测这些事件变得尤为重要。我们提供了一篇关于 ICI 相关急性肾损伤（AKI）的可能机制、相关危险因素以及在慢性肾脏病（CKD）患者中使用 ICI 的最新综述。进行了系统的相关文章检索。急性肾小管间质性肾炎（ATIN）是 ICI 相关 AKI 的主要原因，肾小球肾炎也是一个重要原因。可能的危险因素包括同时使用药物、肾外免疫相关不良反应以及两种或更多免疫治疗药物的联合使用。在 CKD 患者中使用 ICI 可能与总体免疫相关不良反应的发生率增加有关。如果确诊为 ICI 相关肾 AE，建议及时使用类固醇，如果 AKI 严重，则应考虑停用 ICI。
