Table 2.
Reported cases of renal tubular acidosis with use of immune checkpoint inhibitors
| Reported Case | Renal Tubular Acidosis Type | AKI | Cancer | Immune Checkpoint Inhibitor | Serum pH | Serum Potassium, mEq/L | Serum Phosphate, mg/dl | Urine pH | Urine Anion Gap | Kidney Biopsy | Treatment | Outcome | Ref. |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Proximal | No | HCC | N | 7.39 | 1.7 | 1.2 | 7.0 | NR | Not performed | Electrolyte replacement of potassium phosphate | ICI held, acidosis improved | 44 |
| 2 | Proximal | Yes | Lung | P | NR | 2.5 | 1.5 | NR | NR | Not performed | Electrolyte replacement of potassium, phosphate, magnesium, and iv steroids | ICI was held, resolution of electrolyte abnormalities | 45 |
| 3 | Proximal | Yes | Lung | N/P | 7.35 | 4.5 | 2.3 | NR | NR | Not performed | iv bicarbonate therapy and prednisone | ICI held, resolution of electrolyte abnormalities | 46 |
| 4 | Proximal | Yes | Melanoma | I/N | NR | 1.7 | NR | NR | NR | Not performed | iv bicarbonate, steroids and electrolyte replacement | Presented with hypokalemia and paralysis that resolved, rechallenged with P | 43 |
| 5 | Distal | Yes | Lung | N | 7.21 | 2.4 | NR | 6.5 | 22 | Not performed | iv bicarbonate therapy, and dexamethasone 4 mg every 8 h | ICI held | 94 |
| 6 | Distal | Yes | Lung | P | 7.26 | 2.8 | NR | 6.5 | 10 | Tubulointerstitial nephritis | Oral sodium bicarbonate, prednisone | AKI, acidosis improved | 90 |
| 7 | Distal | Yes | Melanoma | N | 7.25 | 4.2 | NR | 6.3 | 48 | Acute and chronic tubulointerstitial nephritis | iv normal saline, oral potassium citrate, prednisone | AKI, acidosis improved | 90 |
| 8 | Distal | Yes | RCC | N | 7.23 | 3.9 | NR | 6.7 | NR | Not performed | Prednisone, oral sodium bicarbonate | ICI held, AKI, acidosis improved | 90 |
| 9 | Distal | No | Lung | N/P | 7.29 | 3.3 | NR | 6.0 | 36 | Interstitial edema, tubulitis of DCT and collecting ducts | Initially oral bicarbonate for a week, then initiated on steroids 1mg/kg per d | ICI held, acidosis improved | 89 |
| 10 | Distal | Yes | Melanoma | P | 7.05 | 3.2 | NR | 6.0 | 49 | Not performed | iv and oral bicarbonate supplementation, prednisone ×15 d | ICI held, acidosis improved | 95 |
| 11 | Distal | No | Melanoma | P | NR | 3.6 | 2.6 | 6.0 | 8 | Not performed | iv and oral steroids | Acidosis improved | 96 |
HCC, hepatocellular carcinoma; N, nivolumab; NR, not reported; ICI, immune checkpoint inhibitor; P, pembrolizumab; iv, intravenous; RCC, renal cell cancer; I, ipilimumab; DCT, distal convoluted tubule.