Immunosuppressants against acute kidney injury: what to prefer or to avoid?

Abstract

Background

Acute kidney injury (AKI) is a critical global health issue associated with high mortality rates, particularly in patients undergoing renal transplants and major surgeries. These individuals often receive immunosuppressants to dampen immune responses, but the impact of these drugs on AKI remains unclear.

Objective

This review aims to provide a detailed understanding of the effects of different classes of immunosuppressants against AKI, elucidating their role in either exacerbating or mitigating the occurrence or progression of AKI.

Methods

Several preclinical and clinical reports were analyzed to evaluate the impact of various immunosuppressants on AKI. Relevant preclinical and clinical studies were reviewed through different databases such as Scopus, PubMed, Google Scholar, and ScienceDirect, and official websites like https://clinicaltrials.gov to understand the mechanisms underlying the effects of immunosuppressants on kidney function.

Results and discussion

Specific immunosuppressants have been linked to the progression of AKI, while others demonstrate renoprotective effects. However, there is no consensus on the preferred or avoided immunosuppressants for AKI patients. This review outlines the classes of immunosuppressants commonly used and their impact on AKI, providing guidance for physicians in selecting appropriate drugs to prevent or ameliorate AKI.

Conclusion

Understanding the effects of immunosuppressants on AKI is crucial for optimizing patient care. This review highlights the need for further research to determine the most suitable immunosuppressants for AKI patients, considering both their efficacy and potential side effects.

Keywords:

• Immune system
• immunosuppressant
• acute kidney injury
• immune checkpoint inhibitors
• monoclonal antibodies

Acknowledgment

ABG sincerely acknowledges the financial support provided by the Birla Institute of Technology and Science-Pilani, Pilani, for carrying out this work.

Authors’ contributions

Swati Mishra conducted the literature research and wrote the manuscript. Vishwadeep Shelke conceptualized, literature research and co-wrote the manuscript. Neha Dagar conducted literature research and co-wrote the manuscript. Maciej Lech participated in designing the manuscript, edited, and prepared it for submission. Anil Bhanudas Gaikwad conceptualized, designed and drafted the manuscript. All authors read and approved the final manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.