Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White Building, Room 270, Boston, MA, 02114, USA.
Abdom Radiol (NY). 2022 Sep;47(9):3301-3307. doi: 10.1007/s00261-022-03594-2. Epub 2022 Jul 1.
Prior case reports have noted an increase in renal size and perinephric stranding accompanying immunotherapy-related renal toxicity due to checkpoint-inhibitor therapy. The purpose of this investigation was to systematically evaluate if immunotherapy-related renal toxicity affects renal size and possible associated imaging findings.
This retrospective multi-hospital study included 25 patients (13 men), mean age 67 years (range 46-83) who received immune-checkpoint inhibitors for cancer treatment, developed biopsy-proven immunotherapy-related nephritis, and who also had abdominal imaging before, during, and after nephritis was diagnosed. Long axis renal diameter, renal corticomedullary differentiation/enhancement and perinephric stranding were evaluated by two readers at three timepoints: (1) prior to checkpoint inhibitor therapy (baseline), (2) after biopsy-proven immunotherapy-related nephritis (post-treatment), and (3) following renal function recovery (follow-up). Intraclass correlation coefficient and Cohen's Kappa were calculated to quantify agreement. Logistic regression analysis was implemented to measure the association between each timepoint and imaging features.
Reader agreement on kidney measurements was excellent (ICC = 0.87). There was an increase in renal size between baseline and post-treatment (p = 0.001), followed by a decrease between post-treatment to follow-up (p < 0.001). Agreement was perfect for abnormal renal corticomedullary differentiation/enhancement (Kappa = 1, p < 0.001) and almost perfect for perinephric stranding (Kappa = 0.97, p < 0.001). Neither post-treatment nor follow-up imaging findings were significantly associated with these findings compared to the baseline (p = 0.2-0.6).
Immunotherapy-related renal toxicity was associated with an increase in renal size coincident with acute renal dysfunction.
先前的病例报告指出，由于检查点抑制剂治疗，免疫治疗相关的肾毒性会导致肾脏增大和肾周条索状影。本研究的目的是系统评估免疫治疗相关的肾毒性是否会影响肾脏大小和可能相关的影像学表现。
本回顾性多中心研究纳入了 25 名（13 名男性）患者，平均年龄 67 岁（范围 46-83 岁），他们因癌症治疗接受了免疫检查点抑制剂治疗，发展为经活检证实的免疫治疗相关肾炎，并且在诊断为肾炎之前、期间和之后都有腹部影像学检查。由两位读者在三个时间点评估长轴肾脏直径、肾皮质髓质分化/增强和肾周条索状影：（1）在检查点抑制剂治疗前（基线），（2）在经活检证实的免疫治疗相关肾炎后（治疗后），以及（3）在肾功能恢复后（随访）。计算了组内相关系数和 Cohen's Kappa 来量化一致性。实施逻辑回归分析来测量每个时间点与影像学特征之间的关联。
读者对肾脏测量的一致性极好（ICC=0.87）。在基线和治疗后之间，肾脏大小增加（p=0.001），随后在治疗后和随访之间，肾脏大小减少（p<0.001）。异常肾皮质髓质分化/增强的一致性为完美（Kappa=1，p<0.001），肾周条索状影的一致性为几乎完美（Kappa=0.97，p<0.001）。与基线相比，治疗后和随访的影像学结果与这些发现均无显著相关性（p=0.2-0.6）。
免疫治疗相关的肾毒性与急性肾功能障碍时的肾脏增大有关。
