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A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease
INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly used to treat cancers. Kidney immune-related adverse events (IRAEs) are now well recognized, with the incidence of IRAEs ranging from 2% to 5%. Most of the initial data related to kidney IRAEs have focused on acute interstitial nephr...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783581/ https://www.ncbi.nlm.nih.gov/pubmed/33426386 http://dx.doi.org/10.1016/j.ekir.2020.10.002 |
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author | Kitchlu, Abhijat Jhaveri, Kenar D. Wadhwani, Shikha Deshpande, Priya Harel, Ziv Kishibe, Teruko Henriksen, Kammi Wanchoo, Rimda |
author_facet | Kitchlu, Abhijat Jhaveri, Kenar D. Wadhwani, Shikha Deshpande, Priya Harel, Ziv Kishibe, Teruko Henriksen, Kammi Wanchoo, Rimda |
author_sort | Kitchlu, Abhijat |
collection | PubMed |
description | INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly used to treat cancers. Kidney immune-related adverse events (IRAEs) are now well recognized, with the incidence of IRAEs ranging from 2% to 5%. Most of the initial data related to kidney IRAEs have focused on acute interstitial nephritis (AIN). There are minimal data on the types and relative frequencies of glomerular diseases associated with ICIs, their treatment, and outcomes. METHODS: We performed a systematic review and meta-analysis of all biopsy-proven published cases/series of glomerular pathology associated with ICIs. We searched the MEDLINE, EMBASE, and Cochrane databases from inception to February 2020. We abstracted patient-level data, including demographics, cancer and ICI therapy details, and characteristics of kidney injury. RESULTS: After screening, 27 articles with 45 cases of biopsy-confirmed ICI-associated glomerular disease were identified. Several lesion types were observed, with the most frequent being pauci-immune glomerulonephritis (GN) and renal vasculitis (27%), podocytopathies (24%), and complement 3 GN (C3GN; 11%). Concomitant AIN was reported in 41%. Most patients had ICIs discontinued (88%), and nearly all received corticosteroid treatment (98%). Renal replacement therapy (RRT) was required in 25%. Most patients had full (31%) or partial (42%) recovery from acute kidney injury (AKI), although 19% remained dialysis-dependent, and approximately one-third died. Complete or partial remission of proteinuria was achieved in 45% and 38%, respectively. CONCLUSION: Multiple forms of ICI-associated glomerular disease have been described. Pauci-immune GN, podocytopathies, and C3GN are the most frequently reported lesions. ICI-associated glomerular disease may be associated with poor kidney and mortality outcomes. Oncologists and nephrologists must be aware of glomerular pathologies associated with ICIs and consider obtaining a kidney biopsy specimen when features atypical for AIN are present. |
format | Online Article Text |
id | pubmed-7783581 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-77835812021-01-08 A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease Kitchlu, Abhijat Jhaveri, Kenar D. Wadhwani, Shikha Deshpande, Priya Harel, Ziv Kishibe, Teruko Henriksen, Kammi Wanchoo, Rimda Kidney Int Rep Clinical Research INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly used to treat cancers. Kidney immune-related adverse events (IRAEs) are now well recognized, with the incidence of IRAEs ranging from 2% to 5%. Most of the initial data related to kidney IRAEs have focused on acute interstitial nephritis (AIN). There are minimal data on the types and relative frequencies of glomerular diseases associated with ICIs, their treatment, and outcomes. METHODS: We performed a systematic review and meta-analysis of all biopsy-proven published cases/series of glomerular pathology associated with ICIs. We searched the MEDLINE, EMBASE, and Cochrane databases from inception to February 2020. We abstracted patient-level data, including demographics, cancer and ICI therapy details, and characteristics of kidney injury. RESULTS: After screening, 27 articles with 45 cases of biopsy-confirmed ICI-associated glomerular disease were identified. Several lesion types were observed, with the most frequent being pauci-immune glomerulonephritis (GN) and renal vasculitis (27%), podocytopathies (24%), and complement 3 GN (C3GN; 11%). Concomitant AIN was reported in 41%. Most patients had ICIs discontinued (88%), and nearly all received corticosteroid treatment (98%). Renal replacement therapy (RRT) was required in 25%. Most patients had full (31%) or partial (42%) recovery from acute kidney injury (AKI), although 19% remained dialysis-dependent, and approximately one-third died. Complete or partial remission of proteinuria was achieved in 45% and 38%, respectively. CONCLUSION: Multiple forms of ICI-associated glomerular disease have been described. Pauci-immune GN, podocytopathies, and C3GN are the most frequently reported lesions. ICI-associated glomerular disease may be associated with poor kidney and mortality outcomes. Oncologists and nephrologists must be aware of glomerular pathologies associated with ICIs and consider obtaining a kidney biopsy specimen when features atypical for AIN are present. Elsevier 2020-10-16 /pmc/articles/PMC7783581/ /pubmed/33426386 http://dx.doi.org/10.1016/j.ekir.2020.10.002 Text en © 2020 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Kitchlu, Abhijat Jhaveri, Kenar D. Wadhwani, Shikha Deshpande, Priya Harel, Ziv Kishibe, Teruko Henriksen, Kammi Wanchoo, Rimda A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease |
title | A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease |
title_full | A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease |
title_fullStr | A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease |
title_full_unstemmed | A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease |
title_short | A Systematic Review of Immune Checkpoint Inhibitor–Associated Glomerular Disease |
title_sort | systematic review of immune checkpoint inhibitor–associated glomerular disease |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783581/ https://www.ncbi.nlm.nih.gov/pubmed/33426386 http://dx.doi.org/10.1016/j.ekir.2020.10.002 |
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