Management of checkpoint inhibitor-associated renal toxicities

ABSTRACT

Introduction: Checkpoint inhibitors have revolutionized the treatment of malignancies and are increasingly used in clinical practice. By inhibiting negative co-stimulatory signaling, checkpoint inhibitors result in augmented T cell activation and are, not surprisingly, commonly associated with various immune-related adverse events. Although renal immune-related adverse events are considered to be rare, these can be severe and sometimes require immunosuppressive treatment with or without discontinuation of checkpoint inhibitor therapy.

Areas covered: In this review, we will focus on the diagnosis and management of checkpoint inhibitor-associated immune-related adverse events. We compile available data from published case reports and case series identified through an extensive search of PubMed, Web of Science and the Cochrane Library, and review of references of identified articles. Based on these data, we provide recommendations regarding renal monitoring in patients receiving checkpoint inhibitors and the treatment of these renal immune-related adverse events. Renal dysfunction in patients receiving checkpoint inhibitor treatment should not be readily attributed to checkpoint inhibitor treatment and a careful diagnostic work-up is needed in every affected patient.

Expert commentary: We recommend performing a renal biopsy whenever important treatment decisions need to be taken to prevent unnecessary initiation of steroids and/or cessation of checkpoint inhibitory treatment.

KEYWORDS:

• Checkpoint inhibitors
• renal toxicity
• acute tubule-interstitial nephritis
• kidney transplantation
• onconephrology
• immune-related adverse events

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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Funding

No funding to declare.