AI Article Synopsis

  • Acute kidney injury (AKI) is a recognized complication in patients receiving immune checkpoint inhibitors, especially those with lung adenocarcinoma, as highlighted in a study of six patients.
  • The study analyzed patient demographics, treatments, and renal function, with biopsies revealing mechanisms of AKI such as acute interstitial nephritis and acute tubular necrosis.
  • Most patients responded well to steroid treatment, and the findings suggest that AKI presentations vary, indicating a need for personalized treatment strategies and further research to identify risk biomarkers.

Article Abstract

Background: Acute kidney injury (AKI) has been well described as a complication of immune checkpoint inhibitor therapy. We present a series of patients, the majority with lung adenocarcinoma, who developed AKI while actively receiving immune checkpoint inhibitors.

Methods: This is a retrospectively analyzed clinical case series of six patients treated at City of Hope Comprehensive Cancer Center. Data were collected on gender, age, ethnicity, comorbidities, concomitant medications, type of malignancy, treatments, and renal function. All patients underwent renal biopsy for classification of the mechanism of AKI. Comprehensive genomic profiling (CGP) was performed on tumor tissue for all patients.

Results: Patterns of AKI included acute interstitial nephritis and acute tubular necrosis. Contributing factors included the use of concomitant medications known to contribute to AKI. All but two patients had full resolution of the AKI with the use of steroids. There were several mutations found on CGP that was notable including an Exon 20 insertion as well as multiple NF1 and TP53 mutations. There was high PD-L1 expression on tumor tissue noted in two out of six patients. In addition to AKI, a subset of patients had proteinuria with biopsies revealing corresponding glomerular lesions of minimal change disease and focal and segmental glomerulosclerosis.

Conclusions: Our case series demonstrates that AKI from immune checkpoint inhibitors has a variable presentation that may require an individualized treatment approach. Further studies are needed to identify biomarkers that may help identify those at risk and guide the management of this condition.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11303352PMC
http://dx.doi.org/10.1007/s00262-024-03775-6DOI Listing

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