Table 4.
Reference | Patients, n | Treatment with Steroids, n (%) | Renal Outcome Data | Rechallenge |
Shirali et al. (16)a | 6 | 5 (83) | 4/5 patients treated with steroids had return of SCr back to baseline; one had an improvement from a peak SCr of 2.5 mg/dl to 1.3 mg/dl, but not back to baseline. One patient who did not receive steroids had furosemide/PPI discontinued, with improvement of SCr back to baseline. | One patient rechallenged and had recurrence of AKI; one patient with ATIN continued on pembrolizumab |
Cortazar et al. (15)b | 13 | 11 (92) | 9/10 patients with ATIN treated with steroids had complete or partial renal recovery. Two patients did not receive IS and had no renal recovery. | Two patients rechallenged without AKI |
Izzedine et al. (17)c | 12 | 7 (58) | 10/12 patients had ICPIs stopped, of whom seven received steroids; one died because of disease progression, the other six had some renal recovery. 2/12 were continued on ICPIs, with some improvement in renal function. | One patient rechallenged with recurrence of ATIN |
Mamlouk et al. (28)d | 16 | 14 (88) | 3/5 ATIN cases all had partial renal recovery after prednisone, one of whom was also treated with infliximab. Two cases had no renal response; 3/16 died because of disease progression. | NR; 13 survivors continued treatment |
Seethapathy et al. (20)e | 30 | 21 (70) | Of the 82 patients with sustained AKI, 54 (67%) died in the follow-up period, death occurred a median of 22 d (IQR 6–84) after the sustained AKI episode. | 17 patients (57%) rechallenged, with nine developing recurrent AKI |
Cortazar et al. (21)f | 138 | 119 (86) | Complete, partial, and no renal recovery after ICPI-AKI occurred in 40%, 45%, and 15% of patients, respectively. Treatment with steroids associated with a 1.7 greater odds of renal recovery in multivariable models among biopsied patients. Patients with no renal recovery had higher mortality than those with complete or partial recovery. | 22% of patients were rechallenged, with recurrent AKI in 23% |
SCr, serum creatinine; PPI, proton pump inhibitor; ATIN, acute tubulointerstitial nephritis; IS, immunosuppression; ICPI, immune checkpoint inhibitor; NR, not recorded; IQR, interquartile range.
Renal recovery not explicitly defined.
Complete recovery defined as return of SCr to <0.35 mg/dl above the baseline value. Partial renal recovery defined as a return of SCr to >0.35 mg/dl but less than twice the baseline value, or liberation from RRT.
Renal recovery not explicitly defined; six patients had a “favorable” renal recovery defined as 50% improvement in eGFR.
Complete recovery defined as return of SCr to <0.35 mg/dl above the baseline value. Partial renal recovery defined as a return of SCr to >0.35 mg/dl but less than twice the baseline value.
Renal recovery not explicitly defined.
Complete recovery was defined as a return of SCr to <0.35 mg/dl of the baseline value, and partial recovery was defined as a return of SCr to >0.35 mg/dl but less than twice the baseline value, or liberation from RRT.