Table 2.

Recommendations of clinical guidelines (NCCN Guidelines for Management of Immunotherapy-Related Toxicities and American Society of Clinical Oncology (ASCO) guidelines) (33, 34) in AKI in patients treated with immunotherapy.

Clinical conditions	Management	Treatment
Mild cases
sCr 1–1.5 x baseline	Withhold ICI Monitor renal function every 3–7 days	Correct dehydration, Withdraw nephrotoxic medication
Proteinuria <1 gr/24 h	Continue ICI	Monitoring
Moderate cases
sCr 1.5–3 x baseline	Withhold ICI Monitor renal function every 3–7 days	Nephrology consultation +/- start corticotherapy (0.5–1 mg/Kg/24 h)
Proteinuria 1–3.5 gr/24 h	Consider kidney biopsy Withhold ICI if kidney biopsy confirms	Treat the renal pathology diagnosed
Severe cases
sCr >3 x baseline or > 4 mg/dl	Kidney biopsy Permanent discontinuation of ICIs	Start corticosteroid therapy (1–2 mg/Kg/24 h)
Proteinuria >3.5 gr/24 h	Kidney biopsy Withhold ICI if kidney biopsy confirms	Treat the renal pathology diagnosed
Life-threating cases
sCr > 6 x baseline or dialysis indicated	Kidney biopsy Permanent discontinuation of ICIs	Intravenous bolus corticosteroid If no response, consider other immunosuppressive agents (MMF, CTX, AZA or infliximab)

AKI, acute kidney injury; MMF, mycophenolate mofetil; CTX, cyclophosphamide; AZA, azathioprine.