Nephrotoxicity of immune checkpoint inhibitors in immunotherapy of oncologic patients

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies directed at negative regulatory components on T cells, such as cytotoxic T lymphocyteassociated antigen 4, programmed cell death-1 (PD-1), and its ligand, programmed cell death ligand-1 (PD-L1).They stimulate the immune system to destroy the cancer cells, however, may lead to immune-related adverse events (irAEs) that affect a variety of organs including the kidney.Kidney damage is characterized most by acute kidney injury (AKI) as well as a subnephrotic syndrome, pyuria or haematuria mainly due to acute tubulointerstitial nephritis.Depending on the symptom severity, after exclusion of other causes of AKI such as infection, dehydration, kidney obstruction, nephrotoxicity related to other nephrotoxic drugs, the management includes ICIs discontinuation and treatment with or without systemic steroids for longer than 4-6 weeks.Kidney biopsy should be considered to rule out other rare kidney complications such as minimal change disease, immune complex glomerulonephritis or thrombotic microangiopathy.In patients with good response and renal symptoms withdrawal, the immunotherapy can be restarted.There are no studies on the use of these drugs in dialysis and transplant patients, only case reports are available, but it seems that the impaired kidney function should not be a contraindication to use ICIs.