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Kidney Week

Abstract: PO0413

Mini-Pulse and Fast-Tapering Corticosteroids in Acute Tubulointerstitial Nephritis Related to Immune Checkpoint Inhibitors: Testing a Treatment Scheme

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Author

  • Rico, Raquel Berzal, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
Background

Acute tubulointerstitial nephritis (ATIN) is the most common lesion seen on kidney biopsy related to immune check-point inhibitors (ICI) in oncological patients. Clinical and laboratory features as well as risk factors are well known, albeit non-specific in predicting the underlying renal lesion. Corticosteroid-based therapy has proven to be effective, however, the optimal duration of treatment has not yet been established.

Methods

We conducted a retrospective single-center study to evaluate a treatment scheme with low-dose corticosteroids in patients diagnosed with ICI-related ATIN between 2017-2021. Extrapolating our treatment scheme for acute interstitial nephritis, we administer pulses of methylprednisolone (2 mg/kg/day for 3 consecutive days) followed by prednisone 1mg/kg/day with rapid-tapering until total withdrawal 2 months after treatment onset. The main outcome was to assess renal response during follow-up.

Results

We included a total of 8 patients (87.5% males) with a median age of 66.5 years and diagnosis of metastatic disease in all cases. Three patients had urothelial cancer, two had renal cell carcinoma and lung cancer, and one had hepatocellular carcinoma. Monotherapy as first- or second-line treatment with PDL-1 and PD-1 inhibitors was employed in 62.5 and 37.5% of the cases, respectively. Baseline serum creatinine(SCr) was 1.1 mg/dl(0.82-1.5), three patients had chronic kidney disease and six patients were on treatment with proton pump inhibitors. Acute kidney injury presented 13.5 weeks after starting ICI therapy. The median highest SCr was 3.2 mg/dl(2.5-5) and one patient required acute dialysis. Urinalysis alterations were present in all patients (proteinuria in 50%, hematuria in 75%, and sterile pyuria in 87.5%). Complete renal response was observed in all cases, except for one patient who showed a partial response. ICI rechallenge was not applied to any patient and no ATIN recurrences were documented after corticosteroids discontinuation. Two patients died due to oncologic disease progression. Median follow-up was 12.5 months(2.5-27.5).

Conclusion

Our treatment scheme with fast-tapering corticosteroids was effective for inducing renal response in ICI-related ATIN, without evidence of relapses.