Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Internal Medicine, Section of Nephrology and Clinical and Translational Research Accelerator, Yale University Medical Center, New Haven, Connecticut, USA.
Curr Opin Nephrol Hypertens. 2022 Sep 1;31(5):449-455. doi: 10.1097/MNH.0000000000000805. Epub 2022 Jul 11.
Immune checkpoint inhibitors (ICIs) have changed the landscape of cancer treatment. However, use of ICIs can be limited by inflammatory toxicities referred to as immune-related adverse events (irAEs). ICI-associated acute kidney injury (ICI-associated AKI) affects 3-5% of ICI users.
With the rapidly growing indication of ICI, knowledge of ICI-associated kidney toxicity has also expanded from case series to large multicentre cohort studies. In this review, we discuss the clinical features, risk factors, clinicopathological correlations and prognosis of ICI-associated AKI from the most recent rigorously conducted retrospective cohort studies. We also discuss recent advances in diagnostic biomarker investigation, treatment and the unique challenge faced in the kidney transplant population.
With more comprehensive understanding of the clinical features and risk factors, ICI-associated AKI is commonly diagnosed clinically, especially given the inherent challenges performing a kidney biopsy in the cancer population; however, this highlights the urgent need for improved noninvasive diagnostic biomarkers to aid diagnosis and prognosis. Prospective studies are needed to better define the optimal treatment of ICI-associated AKI and to minimize the risk of graft loss in patients with kidney transplant who require ICIs.
免疫检查点抑制剂 (ICI) 改变了癌症治疗的格局。然而，ICI 的使用可能会受到被称为免疫相关不良事件 (irAE) 的炎症毒性的限制。ICI 相关性急性肾损伤 (ICI-AKI) 影响 3-5%的 ICI 使用者。
随着 ICI 适应证的迅速扩大，ICI 相关肾毒性的知识也从病例系列扩展到了大型多中心队列研究。在这篇综述中，我们讨论了最近进行的严格回顾性队列研究中 ICI-AKI 的临床特征、危险因素、临床病理相关性和预后。我们还讨论了诊断生物标志物研究、治疗的最新进展以及在肾移植人群中面临的独特挑战。
随着对临床特征和危险因素的更全面了解，临床通常可以诊断出 ICI-AKI，特别是考虑到在癌症人群中进行肾活检存在固有挑战；然而，这凸显了迫切需要改进非侵入性诊断生物标志物来辅助诊断和预后的需求。需要前瞻性研究来更好地定义 ICI-AKI 的最佳治疗方法，并最大程度地降低需要 ICI 的肾移植患者发生移植物丢失的风险。
