Table 3.

Immune checkpoint inhibitor therapy–associated kidney lesions

Reference and CPI Therapy	AKI after CPI Initiation	Kidney Syndrome	Urinalysis/Urine Sediment	Kidney Biopsy	Treatment Data	Outcome Data
Cortazar et al.57
Ipilimumab	54 d	AKI	5–10 WBCs, 2 RBCs	G-AIN	Drug DC, pred	PR
Ipilimumab + nivolumab	91 d	AKI	2–3 WBCs, 3–5 RBCs	G-AIN	Drug DC, pred	CR
Ipilimumab + nivolumab	69 d	AKI	5–10 WBCs, 0 RBCs	G-AIN	Drug DC, pred	PR
Ipilimumab	70 d	AKI	0–2 WBC casts, 16–34 WBCs	AIN	Drug DC only	NR
Ipilimumab + nivolumab	245 d	AKI	5 WBCs, 1 RBC	AIN	Drug DC, MP/pred	PR
Ipilimumab	183 d	AKI	0 WBC, 0 RBC	AIN	Drug DC, MP/pred	NR
Nivolumab	224 d	AKI	0 WBC, 0 RBC	AIN	Drug DC, pred	PR
Ipilimumab	154 d	AKI	6–9 WBCs, 0–3 RBCs	TMA	Drug DC, pred	NR
Ipilimumab + nivolumab	42 d	AKI	9 WBCs, 8 RBCs	AIN	Drug DC, MP/pred, MMF	PR
Ipilimumab	120 d	AKI	3 WBCs/HPF, WBC casts	AIN and ICD	Drug continued	NR
Ipilimumab	60 d	AKI	50–100 WBCs, 0–2 RBCs	AIN	Drug DC, pred	PR
Pembrolizumab	21 d	AKI	20–50 WBCs, 0–2 RBCs	AIN	Drug DC, MP/pred	PR
Pembrolizumab	231 d	AKI	11–20 WBCs, 0 RBCs	AIN	Drug DC, MP/pred	CR
Shirali et al.60
Nivolumab	11 mo	AKI	Bland	AIN	Drug continued initially, then held	CR 6 mo after drug DC
Nivolumab	16 mo	AKI	2 WBC casts/LPF	AIN	Drug DC, pred	CR
Nivolumab + bevacizumab	10 mo	AKI	2–5 WBCs/LPF	AIN	Drug continued, MP/pred	CR
Pembrolizumab	3 mo	AKI	Numerous WBCs/HPF	AIN	Drug DC, pred ×2 courses	CR after second steroid course
Nivolumab + ipilimumab	8 mo	AKI	1 WBC cast/LPF	AIN	Drug DC, recurrent AKI with retrial treated with steroids	CR, recurrent AKI with retrial, PR after steroids
Pembrolizumab	365 d	AKI	15–30 WBCs/HPF	AIN	Drug DC, pred	CR
Izzedine et al.66
Ipilimumab	42 d	AKI	35 WBCs and 70 RBCs/HPF	G-AIN	Drug DC, pred	CR
Ipilimumab	42 d	AKI	N/A	G-AIN	Drug DC, pred	CR
Belliere et al.71
Nivolumab	48 d	AKI	Bland	G-AIN	Drug DC, steroids	PR
Pembrolizumab	137 d	AKI	Bland	AIN	Drug DC, steroids	PR
Ipilimumab	130 d	AKI	Bland	AIN	Drug DC, steroids	CR
Murakami et al.31
Nivolumab + ipilimumab	21 d	AKI	9 WBCs and 8 RBCs/HPF, WBC and granular casts	AIN	Drug DC, MP/pred, MMF after failure	NR, fatal septic shock
Kitchlu et al.62
Pembrolizumab	1 mo	NS, AKI	N/A	MCD, ATI	Drug DC, steroids	PR
Ipilimumab	18 mo	NS	N/A	MCD	Drug DC, pred	CR, NS relapse with retrial, CR with DC
Fadel et al.69
Ipilimumab	21 d	NS	25 RBCs per 1 cubic mm	Lupus GN	Drug DC, pred	CR
Jung et al.70
Nivolumab	10 mo	AKI	Numerous RBCs, 3–5 WBCs, 1–3 granular casts	IgA dominant GN	Drug DC, MP followed by pred	HD dependent for 6 mo, CR off HD
Daanen et al.63
Nivolumab	1.5 mo	NS, AKI	Many hyaline casts, few WBCs/RBCs	FSGS	Drug DC, MP/pred	PR
Kidd and Gizaw55
Ipilimumab	N/A	NS, AKI	N/A	MCD	Drug DC, pred	CR (NS), PR (AKI)

CPI, immune checkpoint inhibitor; WBC, white blood cell; RBC, red blood cell; G-AIN, granulomatous acute interstitial nephritis; DC, discontinued; pred, prednisone; PR, partial remission; CR, complete remission; AIN, acute interstitial nephritis; NR, no response; MP, methylprednisolone; TMA, thrombotic microangiopathy; MMF, mycophenolate mofetil; HPF, high power field; ICD, immune complex deposit; LPF, low power field; N/A, not available; NS, nephrotic syndrome; MCD, minimal change disease; ATI, acute tubular injury; HD, hemodialysis; ; cFSGS, collapsing FSGS.