Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer and are now the backbone of therapy for several malignancies. However, ICIs can cause a spectrum of kidney immune-related adverse events including acute kidney injury (AKI), most commonly manifesting as acute interstitial nephritis (AIN), although glomerular disease and electrolyte disturbances have also been reported. In this position statement by the American Society of Onco-nephrology (ASON), we summarize the incidence and risk factors for ICI-AKI, pathophysiological mechanisms, and clinicopathologic features of ICI-AKI. We also discuss novel diagnostic approaches and promising biomarkers for ICI-AKI. From expert panel consensus, we provide clinical practice points for the initial assessment and diagnosis of ICI-AKI, management and immunosuppressive therapy, and consideration for rechallenge with ICI following AKI episodes. In addition, we explore ICI use in special populations, such as kidney transplant recipients, and propose key areas of focus for future research and clinical investigation.

中文翻译：

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免疫检查点抑制剂相关肾毒性的诊断和管理：美国肿瘤肾病学会的立场声明


免疫检查点抑制剂 （ICI） 彻底改变了癌症的治疗，现在是多种恶性肿瘤的治疗支柱。然而，ICI 可引起一系列肾脏免疫相关不良事件，包括急性肾损伤 （AKI），最常见的表现为急性间质性肾炎 （AIN），尽管也有肾小球疾病和电解质紊乱的报道。在美国肿瘤肾病学会 （ASON） 的这份立场声明中，我们总结了 ICI-AKI 的发病率和危险因素、ICI-AKI 的病理生理机制和临床病理特征。我们还讨论了 ICI-AKI 的新型诊断方法和有前途的生物标志物。根据专家组共识，我们为 ICI-AKI 的初始评估和诊断、管理和免疫抑制治疗以及考虑在 AKI 发作后再次使用 ICI 提供临床实践要点。此外，我们探讨了 ICI 在特殊人群（如肾移植受者）中的应用，并提出了未来研究和临床研究的重点领域。