Immune Checkpoint Inhibitors and the Kidney: A Focus on Diagnosis and Management for Personalised Medicine

Immune-oncology has revolutionized the natural history of many cancers in the past decade, becoming a new therapeutic weapon. The identification of immune “checkpoints” (PD-1/CTLA-4) whose blockade stimulates anti-tumor immunity has changed outcomes for many ptients. However, immune checkpoint inhibitors (ICIs) produce novel response patterns across cancer types and can cause inflammatory side-effects known as immune-related adverse events (irAEs). Renal damage from ICIs is an infrequent event, and early diagnosis plays a key role in its treatment, so it is crucial to recognize and treat it early to avoid toxicities of all grades, as well as hospitalizations. Immunity plays a crucial role in fighting cancer, but tumours can evade the immune system and proliferate and metastasize. Enhancing immune responses is a new challenge in anticancer therapies. In this context, efficacy data are accumulating on immune checkpoint inhibitors and adjuvant therapies for various types of advanced-stage solid tumours. Unfortunately, immune-related adverse events are common. Although infrequent, renal toxicity may occur via several mechanisms and may require temporary or permanent drug suspension, renal biopsy, and/or immunosuppressive treatment. This short review aims to provide a practical approach to the multidisciplinary management of cancer patients with renal toxicity during treatment with immune checkpoint inhibitors.