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Kidney Week

Abstract: PO2165

Immune Checkpoint Inhibitor-Associated Glomerular Disease: A Systematic Review and Meta-Analysis

Session Information

  • Onco-Nephrology - 1
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Kitchlu, Abhijat, University Health Network, Toronto, Ontario, Canada
  • Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Wadhwani, Shikha, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Deshpande, Priya, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Harel, Ziv, St. Michael's Hospital, Toronto, Ontario, Canada
  • Kishibe, Teruko, St. Michael's Hospital, Toronto, Ontario, Canada
  • Henriksen, Kammi J., University of Chicago, Chicago, Illinois, United States
  • Wanchoo, Rimda, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background

Immune checkpoint inhibitors (ICI) are increasingly used to treat several cancers. Kidney immune-related adverse events (IRAE) are now well-recognized, with purported incidence of 2-5%. The majority of initial data related to kidney IRAE has focused on acute interstitial nephritis (AIN). Recently various glomerular diseases have been reported; however, there is minimal data on the types and relative frequencies of glomerular diseases associated with ICI, 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 ICI therapy. We searched the MEDLINE, EMBASE and Cochrane Central databases from inception to February 2020. We abstracted patient-level data, including demographics, cancer and ICI therapy details, and characteristics of kidney injury. We performed exploratory univariate logistic regressions for predictors of end stage kidney disease (ESKD) or death.

Results

After screening, 27 manuscripts with 45 cases of biopsy-confirmed ICI-associated glomerular disease were identified. Several types of lesions were observed, with the most frequent being pauci-immune glomerulonephritis and renal vasculitis (27%), minimal change disease (MCD) (20%), and C3 glomerulonephritis (11%). Concomitant AIN was reported among 41% of cases. The majority of patients had ICI discontinued (88%), and nearly all received corticosteroids (98%). Complete or partial remission of proteinuria was achieved in 45% and 38%, respectively. Most patients had full (31%) or partial (42%) recovery from AKI although 19% required dialysis and approximately one-third of patients died. In exploratory univariate logistic regression for predictors of endstage kidney disease (ESKD) or death, glomerular lesion, ICI class, peak creatinine and proteinuria were not significantly associated with this composite outcome.

Conclusion

Glomerular diseases associated with ICI are not uncommon. Pauci-immune glomerulonephritis, MCD and C3GN are the most frequently reported lesions. ICI-associated glomerular disease may be associated with poor kidney and mortality outcomes. Oncologists and nephrologists need to be aware of glomerular pathologies associated with ICI treatment.