Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports
IntroductionAcute kidney injury (AKI) in cancer patients receiving immune checkpoint inhibitors (ICIs) may recognize multiple causes. Here, we reviewed cases of biopsy-proven acute tubulointerstitial nephritis (ATIN) to describe the clinical characteristics and outcomes of this condition.MethodWe co...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1221135/full |
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| author | Pasquale Esposito Pasquale Esposito Annarita Bottini Elvina Lecini Francesca Cappadona Michela Piaggio Lucia Macciò Carlo Genova Carlo Genova Francesca Viazzi Francesca Viazzi |
| author_facet | Pasquale Esposito Pasquale Esposito Annarita Bottini Elvina Lecini Francesca Cappadona Michela Piaggio Lucia Macciò Carlo Genova Carlo Genova Francesca Viazzi Francesca Viazzi |
| author_sort | Pasquale Esposito |
| collection | DOAJ |
| description | IntroductionAcute kidney injury (AKI) in cancer patients receiving immune checkpoint inhibitors (ICIs) may recognize multiple causes. Here, we reviewed cases of biopsy-proven acute tubulointerstitial nephritis (ATIN) to describe the clinical characteristics and outcomes of this condition.MethodWe conducted a pooled analysis of clinical cases of ICI-related biopsy-proven ATIN up to 1 May 2022. We collected data on clinical characteristics, AKI, biopsy findings, laboratory examinations, and renal outcomes.ResultsEighty-five patients (61.4 ± 19 years, 56 male) were evaluated. Melanoma was the most prevalent diagnosis (51%), followed by non-small cell lung cancer (30%). ICI treatment consisted of PD-1, PDL-1 (nivolumab, pembrolizumab, atezolizumab), and CTLA-4 inhibitors (i) (ipilimumab) or combination PD-1i+CTLA4i. Renal toxicity developed after a median of four cycles of therapy. Fifty-one patients (65.5%) developed the most severe form of AKI- stage 3, including five patients requiring dialysis. All the 19 patients treated with dual ICI blockade developed AKI-stage 3, compared with 29 patients out of the 60 receiving a single agent (p<0.001). Most events were managed with corticosteroids associated with ICI withdrawal. In 15 patients ICI was restarted, but in six (40%) AKI recurred. Overall, 32 patients (40%) presented a complete renal recovery, which chance was inversely associated with dual ICI blockade (OR 0.15, 95CI 0.03-0.7, p=0.01).ConclusionICI-related ATIN may develop late after the therapy initiation, presenting as severe AKI, particularly in patients with dual ICI blockade. Although this complication may be partially reversible, concerns remain about the renal function sequelae and the possibility of restarting ICI treatment. |
| first_indexed | 2024-03-11T16:32:57Z |
| format | Article |
| id | doaj.art-2aef13f7b3f745acac7fca83be6a42da |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-11T16:32:57Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-2aef13f7b3f745acac7fca83be6a42da2023-10-23T21:29:38ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-10-011310.3389/fonc.2023.12211351221135Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reportsPasquale Esposito0Pasquale Esposito1Annarita Bottini2Elvina Lecini3Francesca Cappadona4Michela Piaggio5Lucia Macciò6Carlo Genova7Carlo Genova8Francesca Viazzi9Francesca Viazzi10Nephrology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyDepartment of Internal Medicine, University of Genova, Genova, ItalyDepartment of Internal Medicine, University of Genova, Genova, ItalyDepartment of Internal Medicine, University of Genova, Genova, ItalyNephrology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyDepartment of Internal Medicine, University of Genova, Genova, ItalyDepartment of Internal Medicine, University of Genova, Genova, ItalyDepartment of Internal Medicine, University of Genova, Genova, ItalyUOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, ItalyNephrology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyDepartment of Internal Medicine, University of Genova, Genova, ItalyIntroductionAcute kidney injury (AKI) in cancer patients receiving immune checkpoint inhibitors (ICIs) may recognize multiple causes. Here, we reviewed cases of biopsy-proven acute tubulointerstitial nephritis (ATIN) to describe the clinical characteristics and outcomes of this condition.MethodWe conducted a pooled analysis of clinical cases of ICI-related biopsy-proven ATIN up to 1 May 2022. We collected data on clinical characteristics, AKI, biopsy findings, laboratory examinations, and renal outcomes.ResultsEighty-five patients (61.4 ± 19 years, 56 male) were evaluated. Melanoma was the most prevalent diagnosis (51%), followed by non-small cell lung cancer (30%). ICI treatment consisted of PD-1, PDL-1 (nivolumab, pembrolizumab, atezolizumab), and CTLA-4 inhibitors (i) (ipilimumab) or combination PD-1i+CTLA4i. Renal toxicity developed after a median of four cycles of therapy. Fifty-one patients (65.5%) developed the most severe form of AKI- stage 3, including five patients requiring dialysis. All the 19 patients treated with dual ICI blockade developed AKI-stage 3, compared with 29 patients out of the 60 receiving a single agent (p<0.001). Most events were managed with corticosteroids associated with ICI withdrawal. In 15 patients ICI was restarted, but in six (40%) AKI recurred. Overall, 32 patients (40%) presented a complete renal recovery, which chance was inversely associated with dual ICI blockade (OR 0.15, 95CI 0.03-0.7, p=0.01).ConclusionICI-related ATIN may develop late after the therapy initiation, presenting as severe AKI, particularly in patients with dual ICI blockade. Although this complication may be partially reversible, concerns remain about the renal function sequelae and the possibility of restarting ICI treatment.https://www.frontiersin.org/articles/10.3389/fonc.2023.1221135/fullimmune checkpoint inhibitorscanceracute kidney injuryacute tubulointerstitial nephritispooled analysiscorticosteroids |
| spellingShingle | Pasquale Esposito Pasquale Esposito Annarita Bottini Elvina Lecini Francesca Cappadona Michela Piaggio Lucia Macciò Carlo Genova Carlo Genova Francesca Viazzi Francesca Viazzi Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports Frontiers in Oncology immune checkpoint inhibitors cancer acute kidney injury acute tubulointerstitial nephritis pooled analysis corticosteroids |
| title | Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports |
| title_full | Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports |
| title_fullStr | Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports |
| title_full_unstemmed | Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports |
| title_short | Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports |
| title_sort | biopsy proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors a pooled analysis of case reports |
| topic | immune checkpoint inhibitors cancer acute kidney injury acute tubulointerstitial nephritis pooled analysis corticosteroids |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1221135/full |
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