Kidney Week

Abstract: SA-PO1271

Immune Checkpoint Inhibitor-Associated IgAN: Long-Term Kidney and Patient Outcomes from a Large Single-Center Cohort

Session Information

• Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Aggarwal, Paras, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Paras Aggarwal

• Al Masry, Ahmad, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Ahmad Al Masry, MD

• Youssef, Nada, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Nada Youssef, MD

• Tchakarov, Amanda, McGovern Medical School at UTHealth Houston, Department of Pathology, Houston, Texas, United States

Amanda Tchakarov, MD

• Al Shaarani, Majd, McGovern Medical School at UTHealth Houston, Department of Pathology, Houston, Texas, United States

Majd Al Shaarani, MD

• Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Ala Abudayyeh, MD

• Mamlouk, Omar, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Omar Mamlouk, MBBS, FASN

Background

Glomerulonephritis (GN) remains a rare adverse event, with vasculitis being the most frequently reported GN. While scattered case reports and small multi-center series have described ICI-associated IgA nephropathy (IgAN), comprehensive long-term data remain scarce. We present a large, single-center cohort detailing the clinicopathologic features, kidney outcomes, and patient survival in individuals with ICI-related kidney injury and biopsy-proven IgA deposits.

Methods

We conducted a retrospective analysis of patients at our center who developed ICI-related kidney injury or severe proteinuria and underwent a native kidney biopsy demonstrating IgA nephropathy or IgA staining. We extracted baseline demographics, comorbidities, oncology history, kidney injury severity, histopathology, treatment strategies, and long-term kidney and patient outcomes. For proteinuria, partial recovery was defined as a decrease of < 50% from the time of diagnosis

Results

The cohort included 15 patients. The median age was 67.8 years (range 31.2–80.8); 66.7% (10/15) were male. Patients received a median of 2 ICI cycles prior to presentation, and 6 patients were on combination ICI therapy. The median time from ICI initiation to kidney injury was 69 days. Median baseline serum creatinine was 0.8 mg/dL. The median AKI severity was Stage 2, with 4 patients (26.7%) requiring dialysis. Microscopic hematuria was present in 13 patients (86.7%), and median proteinuria was 0.95 g/day.
Kidney biopsies revealed IgA nephropathy in 10 cases. Of these, 4 had concurrent distinct pathologies: AIN (1), acute tubular injury (ATI) (1), diabetic nephropathy (DN) (1), and thrombotic microangiopathy (1).
Regarding treatment, 6 patients received prednisone, with 5/6 (83%) achieving partial kidney recovery. Overall kidney recovery was complete in 2 patients, partial in 8, and absent in 3. At 6 months, proteinuria recovery was complete in 3 patients, partial in 2, and 2 showed no response.

Conclusion

IgA nephropathy is a notable glomerular complication that can present with significant AKI and proteinuria. While corticosteroid therapy often facilitates recovery, the frequent coexistence of IgAN with other pathologies makes kidney biopsy essential. Ultimately, IgAN appears to carry a more favorable long-term prognosis for both kidney and cancer outcomes.