Nephrology (Kidney)

Immune checkpoint inhibition (ICI) has been very effective in cancer treatment and has changed the treatment paradigm for many cancers. ICIs act by releasing the natural regulators of the immune system, leading to overall immune activation and stimulation of the immune system against antigens in tumors. The inhibitors target cytotoxic T-lymphocyte-associated antigen-4, programmed cell death protein 1, and programmed death ligand-1. These accentuated antitumor effects are associated with off-target side effects, so maximizing the antitumor effects ICI while preventing the off-target effects is challenging. The term immune-related adverse event (irAE) was coined to denote a toxic effect associated with ICI that can involve any organ in the body, including the kidneys. Although the incidence rates for renal irAEs are reported to be only 1–5%, the decline in kidney function associated with ICI would impact survival and eligibility for further clinical trials. Therefore, appreciation of close monitoring of kidney function to preserve and optimize it during ICI has grown. In this chapter, we present the incidence of renal irAEs of, risk factors for, clinicopathologic features of, treatment strategies for, challenges associated with, and a proposed algorithm for diagnosis and management of renal irAEs.