Favors Performing Kidney Biopsy to Conclusively Diagnose Etiology of ICI-Induced AKI

Favors Empiric Treatment of Presumed ICI-Induced AIN

•Grade 2 or 3 AKI •Lack of other concurrent immune-related adverse event at the time of AKI and no concomitant AIN-associated medications (PPI, NSAIDS, antibiotics) •Other potential etiologies that are equally likely and cannot be ruled out with history or laboratory testing along •Concurrently receiving other nephrotoxic antineoplastic therapies •Presence of proteinuria >1 g/day •Serologic abnormalities (such as positive ANCA, hypocomplementemia) •Low risk for biopsy procedure (BMI <30 kg/m2, no prior episodes of significant bleeding, no current coagulopathy, well controlled hypertension, not on antiplatelets or anticoagulants)

•Concurrently experiencing other nonrenal immune-related adverse events •Concurrently taking other AIN-associated medications (PPI, NSAIDS, antibiotics) •One or more risk factors for bleeding complications (BMI >30 kg/m2, prior intracranial or transfusion-requiring bleeding, uncontrolled hypertension with SBP >160 mm Hg despite antihypertensives, on antiplatelets or anticoagulants, patient with altered mental status, mechanical ventilation) •Solitary functioning kidney or multiple cysts in the kidney •Urgent need to treat with empiric steroids (AKI-requiring RRT) when kidney biopsy is not immediately feasible.