Abstract: TH-PO0177
Managing AKI in Immune Checkpoint Inhibitor Therapy: A Comprehensive Cancer Center Experience
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Inácio, António da Silva, Unidade Local de Saude da Arrabida, Setúbal Municipality, Setubal, Portugal
- Ribeiro, Ligia Catarina, Unidade Local de Saude de Castelo Branco EPE, Castelo Branco, Castelo Branco District, Portugal
- Coelho, Inês Dionisio, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal
- Ferreira, Hugo, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal
- Chuva, Teresa, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal
- Paiva, Ana Maria, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal
- Rosinha, Alina Oliveir, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal
- Costa, José Maximino, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Porto District, Portugal
Background
Immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI), though uncommon, may cause significant morbidity. We report the experience of a multidisciplinary team-embedded Nephrology Department at a Comprehensive Cancer Center in managing AKI during ICI treatment.
Methods
Retrospective analysis of Nephrology referrals for suspected ICI-AKI from April 2023 to March 2025 at IPO-Porto. AKI was graded per CTCAE. Continuous variables are reported as median (IQR).
Results
We analyzed 19 patients, 57,9% female (n=11), age 67 (53,5-75). Most common cancers: breast (36,8%, n=7), skin (31,6%, n=6), and digestive (15,8%, n=3). Pembrolizumab was used in 63,2% (n=12); ipilimumab/nivolumab in 15,8% (n=3); cemiplimab in 10,5% (n=2); and dostarlimab and tislelizumab in 5,3% (n=1) each. Time from ICI start to AKI was 3,8 (2,5-7,2) months, with 73,7% (n=14) occurring between 2 months and one year. In 52,6% (n=10) AKI was detected only by protocol labs; the remaining were symptomatic, most commonly febrile (77,8%, n=7). CRP was 124,7 (69,5-156,0) mg/L. Severe AKI (grade 3 or 4) occurred in 57,9% (n=11). Four underwent biopsy: 3 interstitial nephritis, 1 pure ATN - this patient was afebrile with normal CRP. All patients were treated with steroids. Treatment began 7 (3-11,5) days after symptom onset/lab abnormalities, lasting 50 (42-66) days. Pulse steroids were used in 21,1% (n=4), all with grade 4 AKI. Most received 1mg/kg (73,7%, n=14). Full recovery occurred in 89,5% (n=17), and 5,3% (n=1) progressed to ESKD. Dialysis was needed at presentation in one case, with complete recovery. Overall mortality was 26,3% (n=5): 3 due to cancer, 2 infection-related; 4 had recovered from AKI, 1 had ESKD. Rechallenge was performed in 42,1% (n=8). Only one relapse occurred: grade 3 AKI (partial recovery), in the sole rechallenge with combination therapy.
Conclusion
Nephrology referrals due to suspected ICI-AKI were often severe but responded well to steroids. AKI typically occurred in the first year, often with systemic inflammation and fever. Relapse post-rechallenge was rare, occurring under combination ICI. Lab monitoring is essential, as symptoms may be absent. Multidisciplinary care warrants timely referral, diagnosis and treatment.