Immunological mechanisms underlying clinical phenotypes and noninvasive diagnosis of immune checkpoint inhibitor‐induced kidney disease

Abstract

SummaryImmune checkpoint inhibitors (ICIs) have become a mainstay of cancer therapy, with over 80 FDA‐approved indications. Used in a variety of settings and in combination with each other and with traditional chemotherapies, the hyperactive immune response induced by ICIs can often lead to immune‐related adverse events in bystander normal tissues such as the kidneys, lungs, and the heart. In the kidneys, this immune‐related adverse event manifests as acute interstitial nephritis (ICI‐AIN). In the era of widespread ICI use, it becomes vital to understand the clinical manifestations of ICI‐AIN and the importance of prompt diagnosis and management of these complications. In this review, we delve into the clinical phenotypes of ICI‐AIN and how they differ from traditional drug‐induced AIN. We also detail what is known about the mechanistic underpinnings of ICI‐AIN and the important diagnostic and therapeutic implications behind harnessing those mechanisms to further our understanding of these events and to formulate effective treatment plans to manage ICI‐AIN.