Acute Kidney Injury in Cancer Immunotherapy Recipients

Abstract

Cancer immunotherapy has now entered clinical practice and has reshaped the standard of care for many cancer patients. With these new strategies, specific toxicities have emerged, and renal side effects have been described. In this review, we will describe the causes of acute kidney injury in CAR T cell, immune checkpoint inhibitors and other cancer immuno-therapy recipients. CAR T cell therapy and bispecific T cell engaging antibodies can lead to acute kidney injury as a consequence of cytokine release syndrome, tumor lysis syndrome, sepsis or specific CAR T cell infiltration. Immune checkpoint blockade most often results in acute tubular interstitial nephritis, but glomerular diseases have also been described. Although the pathophysiology remains mostly elusive, we will describe the mechanisms of renal damage in these contexts, its prognosis and treatment. As the place of immunotherapy in the anti-cancer armamentarium is exponentially increasing, close collaboration between nephrologists and oncologists is of utmost importance to provide the best standard of care for these patients.

Keywords: acute kidney injury; cancer; chimeric antigen receptor T cell therapy; immune checkpoint inhibitors; immunotherapy.

Figure 1

Acute kidney injury causes in cancer immunotherapy recipients and their site of injury in the nephron. We are grateful to Arkana Laboratories (Little Rock, AR, USA) for authorization to use renal pathology images.