Herrmann Sandra M, Abudayyeh Ala, Gupta Shruti, Gudsoorkar Prakash, Klomjit Nattawat, Motwani Shveta S, Karam Sabine, Costa E Silva Verônica T, Khalid Sheikh B, Anand Shuchi, Kala Jaya, Leaf David E, Murakami Naoka, Rashidi Arash, Wanchoo Rimda, Kitchlu Abhijat
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
Section of Nephrology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
Kidney Int. 2025 Jan;107(1):21-32. doi: 10.1016/j.kint.2024.09.017. Epub 2024 Oct 24.
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer and are now the backbone of therapy for several malignancies. However, ICIs can cause a spectrum of kidney immune-related adverse events including acute kidney injury (AKI), most commonly manifesting as acute interstitial nephritis (AIN), although glomerular disease and electrolyte disturbances have also been reported. In this position statement by the American Society of Onco-nephrology (ASON), we summarize the incidence and risk factors for ICI-AKI, pathophysiological mechanisms, and clinicopathologic features of ICI-AKI. We also discuss novel diagnostic approaches and promising biomarkers for ICI-AKI. From expert panel consensus, we provide clinical practice points for the initial assessment and diagnosis of ICI-AKI, management and immunosuppressive therapy, and consideration for rechallenge with ICI following AKI episodes. In addition, we explore ICI use in special populations, such as kidney transplant recipients, and propose key areas of focus for future research and clinical investigation.
免疫检查点抑制剂（ICIs）彻底改变了癌症治疗方式，如今已成为多种恶性肿瘤治疗的核心。然而，ICIs可引发一系列与肾脏免疫相关的不良事件，包括急性肾损伤（AKI），最常见的表现为急性间质性肾炎（AIN），不过也有肾小球疾病和电解质紊乱的报道。在美国肿瘤肾脏病学会（ASON）的这份立场声明中，我们总结了ICI-AKI的发病率和危险因素、病理生理机制以及临床病理特征。我们还讨论了ICI-AKI的新型诊断方法和有前景的生物标志物。基于专家小组共识，我们提供了ICI-AKI初始评估与诊断、管理和免疫抑制治疗以及AKI发作后考虑再次使用ICI的临床实践要点。此外，我们探讨了ICIs在特殊人群（如肾移植受者）中的应用，并提出了未来研究和临床调查的重点关键领域。
