The differentiation and intervention strategies for acute kidney injury after or induced by immune checkpoint inhibitors.

Abstract

With the increasing popularity of immune checkpoint inhibitors (ICIs) in tumor treatment, the incidence of immune-related adverse events (irAEs), including acute kidney injury (AKI), is on the rise. Renal biopsy serves as the gold standard for determining the true etiology of AKI following ICIs administration; however, due to potential risks and associated losses with this procedure, comprehensive analysis of physiological data and predictive models are gradually being incorporated into clinical practice to differentiate AKI etiologies. These include criteria such as a ≥ 100% increase in serum creatinine (Scr) from baseline or a 50% increase accompanied by other pathological manifestations, renal replacement therapy (RRT), or absence of any other reasonable cause. Currently, cessation of ICIs and steroid therapy represent commonly employed treatment approaches; nevertheless, these strategies have inherent side effects and may not be feasible for certain patient populations, such as those with diabetes, posing challenges for clinicians. Recent studies have demonstrated that rituximab, mycophenolate mofetil (MMF), and infliximab can potentially replace steroid therapy in managing ICIs-induced AKI (ICIs-AKI), offering a novel therapeutic perspective. This review provides an overview of non-invasive methods for distinguishing between AKI following ICIs use and ICIs-AKI while discussing strategies for treating ICIs-AKI.