Abstract:

Immune checkpoint inhibitors (ICIs) are commonly used in cancer immunotherapy, mainly including monoclonal antibodies against target antigens such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed death protein-1 (PD-1), and its ligand (PD-L1). Renal immune-related adverse events (irAE) are caused by ICIs-induced immune enhancement, including solitary electrolyte imbalance, proteinuria, and even dialysis-dependent acute kidney injury, with tubulointerstitial inflammation as the most common pathological finding. The renal irAEs can be induced through mechanisms of the destruction of peripheral immune tolerance and the activation of self-reactive or drug-specific reactive T cells, and can be affected by individual susceptibility factors, different drug types, single-agent or combination therapy, low baseline eGFR, combined-use of proton pump inhibitors (PPI), and age, etc. Raising awareness, early diagnosis, and early identification of the types of renal complications are the prerequisites for obtaining the best therapeutic effect, and renal biopsy is recommended to assist both diagnosis and prognosis judgment in complex situations. Timely and reasonable treatment plan based on glucocorticoids may help improve the renal prognosis.

Key words: Immune checkpoint inhibitors, Immune-related adverse events, Re-activation of T cells, Proton pump inhibitor, Acute kidney injury, Tubulointerstitial inflammation