Immune Checkpoint Inhibitors and Kidney Toxicity: Advances in Diagnosis and Management

. 2021 Oct 8;3(6):1074–1081. doi: 10.1016/j.xkme.2021.08.008

Factors Favoring Quick Steroid Taper and ICI Rechallenge	Factors Favoring Longer Steroid Course and Avoiding ICI Rechallenge
• No other severe immune-related adverse events (myocarditis, myositis, pneumonitis, hepatitis, neurologic immune-related adverse events) • AKI that recovers quickly with corticosteroids (begins improving in <1 week) • Other AIN-associated medications that can be discontinued (PPI, NSAIDs, antibiotics, etc.) • Biopsy or clinical features of AIN (as opposed to other immune-mediated glomerular diseases) • Newly starting therapy (patient has likely not yet derived possible anticancer benefit) • Melanoma and other ICI-sensitive tumors • ICI used has a short half-life	• AKI slowly recovering with <25% change in creatinine by 5-7 days • Evidence of ICI-associated glomerular disease on biopsy or nephrotic-range proteinuria • No concomitant AIN triggering medications • Other life-threatening immune-related adverse events (myocarditis, myositis, pneumonitis, hepatitis, or neurologic) • Cancers that are not particularly sensitive to ICIs • Longer duration on therapy and stable cancer (suggesting that whatever benefits are to be gained have already been realized and cancer is likely to be stable off ICIs)

Factors Favoring Quick Steroid Taper and ICI Rechallenge

Factors Favoring Longer Steroid Course and Avoiding ICI Rechallenge

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No other severe immune-related adverse events (myocarditis, myositis, pneumonitis, hepatitis, neurologic immune-related adverse events)
•
AKI that recovers quickly with corticosteroids (begins improving in <1 week)
•
Other AIN-associated medications that can be discontinued (PPI, NSAIDs, antibiotics, etc.)
•
Biopsy or clinical features of AIN (as opposed to other immune-mediated glomerular diseases)
•
Newly starting therapy (patient has likely not yet derived possible anticancer benefit)
•
Melanoma and other ICI-sensitive tumors
•
ICI used has a short half-life

•
AKI slowly recovering with <25% change in creatinine by 5-7 days
•
Evidence of ICI-associated glomerular disease on biopsy or nephrotic-range proteinuria
•
No concomitant AIN triggering medications
•
Other life-threatening immune-related adverse events (myocarditis, myositis, pneumonitis, hepatitis, or neurologic)
•
Cancers that are not particularly sensitive to ICIs
•
Longer duration on therapy and stable cancer (suggesting that whatever benefits are to be gained have already been realized and cancer is likely to be stable off ICIs)