Renal complications of immune checkpoint blockade

Abstract

Immune checkpoint inhibitors have been approved for a variety of cancer species. Renal complications in use of these agents are not very common compared with other immune-related adverse events (irAE). However, it is crucial for physicians to recognize and manage renal manifestations of irAE. In this review, we will summarize the up-to-date knowledge of the clinical presentation, pathologic features, and management of renal irAE. In addition, we will discuss the safety of immune checkpoint inhibitors in patients with chronic kidney disease as well as in kidney transplant recipients.

Keywords: CTLA-4; Immune check point inhibitor; PD-1; acute kidney injury; chronic kidney injury; transplant.

Figure 1

Cancer-immunity cycle and immune checkpoint inhibitors. Cancer cells release tumor neoantigens (1), which are carried to lymph nodes by antigen-presenting cells (APCs) (2). APCs present tumor antigens to T cells, which are primed and activated (3). Once T cells are activated, they migrate from the lymphoid organ to the tumor (4), where they identify target tumor cells and deliver killing signals (5). Anti-CTLA4 antibody blocks CTLA4-B7 interaction (3) thereby helps B7-CD28 engagement and T cell activation in the secondary lymphoid organ, whereas anti-PD-1 antibody unleashes the inhibitory PD-1:PD-L1 signal (5), and enables cytotoxic killing of tumor cells by T cells in the target tissue.