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. 2020 Mar 30;11(6):1746–1751. doi: 10.1111/1759-7714.13405

Table 3.

Management of AKI (NCCN 2019 V2 management of immunotherapy‐related toxicities)

Conditions Work‐up Management
Mild (Grade 1)

sCr 1–1.5 × baseline

or increase 0.3 mg/day(26.52 μmol/L)

  • Withhold ICIs

  • Correct dehydration, withdraw nephrotoxic medication,

  • Monitor sCr and Upro at least every 3–7 days
Moderate (Grade 2)

sCr 1.5–3 × baseline

  • Withhold ICIs

  • Monitor sCr and Upro at least every 3–7 days

  • Rule out other causes, correct dehydration, withdraw nephrotoxic medication

  • Nephrology consultation

  • Start prednisolone 0.5–1.0 mg/kg/day;

  • For persistent G2 > 1 week, prednisolone 1.0–2.0 mg/kg/day
Severe (Grade 3)

sCr >3 × baseline

or > 4 mg/dL

(353.6 μmol/L)

  • Permanently discontinue ICIs

  • Consider inpatient care

  • Nephrology consultation and renal biopsy

  • Start prednisolone 1.0–2.0 mg/kg/day
Life‐threatening (Grade 4)

sCr >6 × baseline

or dialysis indicated

  • Initiate treatment with intravenous methylprednisolone;

  • If >G2 after 1 week of steroids, consider other immunosuppressive therapy (MMF, CTX, AZA, infliximab)

AZA, azathioprine; CsA, cyclosporine; CTX, cyclophosphamide; MMF, mycophenolat; sCr, serum creatinine.