Kidney Week

Abstract: SA-PO1229

Granulomatous Acute Interstitial Nephritis in Patients Receiving Immune Checkpoint Inhibitor Therapy: Clinical Outcomes and Tumor Necrosis Factor (TNF)-α Expression

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

• Boldt, Christopher, Baylor College of Medicine, Houston, Texas, United States

Christopher Boldt, MD

• Anderson, Isabella, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States

Isabella Anderson, MD

• Shaikh, Rayyan A., The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Rayyan A. Shaikh

• Tchakarov, Amanda, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States

Amanda Tchakarov, MD

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

Nada Youssef, MD

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

Omar Mamlouk, MBBS, FASN

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

Ala Abudayyeh, MD

Background

Acute interstitial nephritis (AIN) is the most common manifestation of immune checkpoint inhibitor (ICI) toxicity, with growing evidence of increased TNF-α expression in kidney tissue, serum, and urine. We compared treatment with glucocorticoids plus infliximab versus glucocorticoids alone in stage III/IV ICI-AIN in patients with granulomatous AIN versus those without. Retrospective NanoString analysis is underway on kidney samples to identify associated gene signatures and possible TNF-α associations in both groups.

Methods

We reviewed 261 renal biopsies (2015–2024), identifying 63 patients with stage III/IV AKI, including 17 with granulomatous AIN post-ICI. Renal response was defined by creatinine changes at 3 months post-AKI as complete, partial, or none. Time to renal response (TTR), duration of renal response (DORR), cancer progression-free survival (PFS), and overall survival (OS) were estimated by Kaplan-Meier analysis. NanoString spatial genetic analysis comparing ICI-induced granulomatous versus non-granulomatous AIN is underway.

Results

Most patients had baseline CKD stage II. Renal response occurred in 88.2% of granuloma cases versus 95.7% without granuloma. Groups were similar in dual ICI exposure, prior steroids, or other IRAEs. All granuloma patients received prednisone; 38% also received infliximab. Median time from ICI to AKI was 77 days (3.5 cycles), and median steroid duration was 3 weeks. Melanoma was most common (44%). Infliximab-treated patients had larger creatinine declines (–3.3 vs –1.8 mg/dL), not statistically significant (p>0.05). Higher response rates were observed in non-granuloma patients treated with steroid + infliximab and granuloma patients treated with steroid alone versus granuloma patients treated with both (100% vs 66.7%; p=0.0438).

Conclusion

In the absence of definitive pathological markers to guide therapy, granulomatous AIN represents a rare but challenging form of interstitial nephritis. It’s often-intense inflammatory activity necessitates prompt intervention and may warrant earlier consideration of TNF-alpha blockade. Ongoing nanostring analyses are evaluating potential associations with TNF alpha, PDL-1 and other gene signatures with renal and tumor response.