Table 1.

Comparison of Guidelines Based Recommendations for Management of ICI-Induced AKI

Management	NCCN	SITC	ASCO
Immunotherapy	G1 & G2: Hold; G3 & G4: Permanently discontinue	G1 & G2: Hold; G3 & G4: Permanently discontinue	G1 & G2: Hold; G3 & G4: Permanently discontinue
Kidney Biopsy	Consider for G3	No recommendation	Consider kidney biopsy if alternative causes cannot be ruled out
Corticosteroid Taper	G1: None; G2: 0.5-1 mg/kg/day; G3/G4: 1-2 mg/kg/day; Taper over 4-6 weeks once Cr <=G1; Monitor Cr weekly	Dose/schedule to be individualized and based on grade	G1: None; G2: 0.5-1 mg/kg/day; G3/G4 or no improvement or worsening in G2: 1-2 mg/kg/day; Taper over 4-6 weeks once Cr <=G1; Monitor Cr weekly
Other immunosuppression	Add immunosuppression (cyclophosphamide, mycophenolate, azathioprine, infliximab) if Cr> G2 after 1 week	No recommendation	Add immunosuppression(e.g. Mycophenolate) of worsening or no improvement in: 7 days (G2)/3-5 days (G3)/2-3 days (G4)

Note: Recommendations by major societies or expert working groups on the management of checkpoint inhibitor related acute kidney injury.^43,44,63 Grading of renal immune-related adverse event is based on CTCAE (Common Terminology Criteria for Adverse Events) v5.0 criteria and is defined by elevation of creatinine above baseline.⁵⁴ Mild (G1): 1.5-2× baseline Cr or 0.3 mg/dL elevation above baseline; Moderate (G2): 2-3× baseline Cr; Severe (G3): >3× baseline Cr; Life-threatening (G4): >6× baseline Cr or dialysis indicated.

Abbreviations: ASCO, American Society of Clinical Oncology; Cr, creatinine; NCCN, National Comprehensive Cancer Network; SITC, Society for Immunotherapy of Cancer.