Table 4.

Renal outcomes among patients with immune checkpoint inhibitor–associated AKI

ReferencePatients, nTreatment with Steroids, n (%)Renal Outcome DataRechallenge
Shirali et al. (16)a65 (83)4/5 patients treated with steroids had return of SCr back to baseline; one had an improvement from a peak SCr of 2.5 mg/dl to 1.3 mg/dl, but not back to baseline. One patient who did not receive steroids had furosemide/PPI discontinued, with improvement of SCr back to baseline.One patient rechallenged and had recurrence of AKI; one patient with ATIN continued on pembrolizumab
Cortazar et al. (15)b1311 (92)9/10 patients with ATIN treated with steroids had complete or partial renal recovery. Two patients did not receive IS and had no renal recovery.Two patients rechallenged without AKI
Izzedine et al. (17)c127 (58)10/12 patients had ICPIs stopped, of whom seven received steroids; one died because of disease progression, the other six had some renal recovery. 2/12 were continued on ICPIs, with some improvement in renal function.One patient rechallenged with recurrence of ATIN
Mamlouk et al. (28)d1614 (88)3/5 ATIN cases all had partial renal recovery after prednisone, one of whom was also treated with infliximab. Two cases had no renal response; 3/16 died because of disease progression.NR; 13 survivors continued treatment
Seethapathy et al. (20)e3021 (70)Of the 82 patients with sustained AKI, 54 (67%) died in the follow-up period, death occurred a median of 22 d (IQR 6–84) after the sustained AKI episode.17 patients (57%) rechallenged, with nine developing recurrent AKI
Cortazar et al. (21)f138119 (86)Complete, partial, and no renal recovery after ICPI-AKI occurred in 40%, 45%, and 15% of patients, respectively. Treatment with steroids associated with a 1.7 greater odds of renal recovery in multivariable models among biopsied patients. Patients with no renal recovery had higher mortality than those with complete or partial recovery.22% of patients were rechallenged, with recurrent AKI in 23%
  • SCr, serum creatinine; PPI, proton pump inhibitor; ATIN, acute tubulointerstitial nephritis; IS, immunosuppression; ICPI, immune checkpoint inhibitor; NR, not recorded; IQR, interquartile range.

  • a Renal recovery not explicitly defined.

  • b Complete recovery defined as return of SCr to <0.35 mg/dl above the baseline value. Partial renal recovery defined as a return of SCr to >0.35 mg/dl but less than twice the baseline value, or liberation from RRT.

  • c Renal recovery not explicitly defined; six patients had a “favorable” renal recovery defined as 50% improvement in eGFR.

  • d Complete recovery defined as return of SCr to <0.35 mg/dl above the baseline value. Partial renal recovery defined as a return of SCr to >0.35 mg/dl but less than twice the baseline value.

  • e Renal recovery not explicitly defined.

  • f Complete recovery was defined as a return of SCr to <0.35 mg/dl of the baseline value, and partial recovery was defined as a return of SCr to >0.35 mg/dl but less than twice the baseline value, or liberation from RRT.