Table 1.
Clinical characteristics of the patients on immune checkpoint inhibitor therapy who developed acute kidney injury.
| Case Ref. |
Malignancy Age/sex |
Co-morbidities | non-ICI drugs associated with AIN | ICI therapy Number of ICI cycles |
Other IRAEs | AKI: Cr change* AKI stage† |
UA UPCR |
Renal pathology IFTA% GS% |
Cancer Response |
|---|---|---|---|---|---|---|---|---|---|
| Case 1 | Stage 3c Squamous cell ca left lung 77/M |
HTN COPD Afib CAD/CABG CKD 4 |
Pantoprazole | Durvalumab 3 cycles |
Pneumonitis | Cr 2.45 > 8.56 AKI stage 3 |
6–10 RBC/HPF 21–50 WBC/HPF 0.31 g/g |
AIN IFTA 40% GS 56% |
PFS 20 months |
| Case 2 | Stage 4 Malignant Melanoma 48/M |
None | None | Ipilimumab, Nivolumab 3 cycles |
Rash Colitis |
Cr 0.91 > 3.16 AKI stage 3 |
19 WBC/HPF 4 RBC/HPF 0.58 g/g |
AIN IFTA 10% GS 6% |
No evidence of disease |
| Case 3 | Stage Ib Malignant Melanoma of esophagus 77/M |
Adenoca esophagus HTN T2DM Hypothyroidism |
Omeprazole | Ipilimumab, Nivolumab 7 cycles |
Colitis | Cr 1.07 > 2.43 AKI stage 2 |
0 RBC/HPF 0 WBC/HPF 0.42 g/g |
AIN IFTA 10% GS 16% |
No evidence of disease |
| Case 4 | Stage 4 Uveal Melanoma 70 F |
T2DM Afib CVA |
Omeprazole | Ipilimumab + Nivolumab 2 cycles |
Dermatitis Hypothyroid Hypophysitis Colitis |
Cr 1.45 > 4.89 AKI stage 3 |
6 RBC/HPF 31 WBC/HPF 0.80 g/g |
Vasculitis without glomerular involvement IFTA 30% GS 50% | PFS 6 months |
| Case 5 | Stage 4 Squamous cell ca oropharynx 41/M |
Hypothyroidism | None | Pembrolizumab 24 cycles |
Colitis | Cr 0.83 > 1.89 AKI stage 2 |
0 RBC/HPF 0 WBC/HPF 0.06 g/g |
HTN nephrosclerosis IFTA 5% GS 5% |
PFS 27 months |
Afib, atrial fibrillation; AIN, acute interstitial nephritis; AKI, acute kidney injury; ATI acute tubular injury; CABG, coronary artery bypass graft; CAD, coronary artery disease; CIN chronic interstitial nephritis; COPD, chronic obstructive pulmonary disease; Cr, serum creatinine (mg/dl); CVA, cerebrovascular accident; GS, glomerular sclerosis; HLD, hyperlipidemia; HPF, high power field; HTN, hypertension; ICI, immune checkpoint inhibitor; IFTA, interstitial fibrosis tubular atrophy; IRAE, immune-related adverse events; M, male; F, female; T2DM, type 2 diabetes mellitus; UA, urinalysis; UPCR, urine protein to creatinine ratio.
*baseline serum creatinine and peak serum creatinine; †AKI stage by KDIGO criteria