# Kidney inflammation (immune-related nephritis) from checkpoint inhibitors

Source: https://onco.cc/protocols/irae-nephritis/  
OnCo record `irae-nephritis` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Immunotherapy can occasionally inflame the kidneys. It usually causes no symptoms and is found when the creatinine on a routine blood test rises. Other causes are looked for first, some medicines may be stopped, immunotherapy is paused, and steroids are given if the immunotherapy is the cause. Some people can later restart.

## Summary

Acute kidney injury is common on checkpoint inhibitors (up to 20% in observational data) but only about 2 to 5% is caused by the checkpoint inhibitor (ADQI 2026). Tubulointerstitial nephritis is the commonest lesion (80 to 90% of biopsies); glomerular disease is rarer. Pooled-trial incidence is about 2% on PD-(L)1 inhibitors or ipilimumab and 5% on the combination (SITC 2021).

SITC 2021: urinalysis and spot urine protein to creatinine ratio (a normal urinalysis does not exclude nephritis); stop drugs known to cause interstitial nephritis, including NSAIDs and proton pump inhibitors; hold the checkpoint inhibitor at KDIGO stage 1 while reversible causes are treated, restarting if the injury resolves; at stage 2 or 3 or significant proteinuria, withhold and refer urgently to nephrology; strongly consider biopsy. Glucocorticoids are first-line (LE: 3); infliximab or mycophenolate for steroid-refractory nephritis (LE: 4).

ADQI 2026 (abstract): no clinical feature reliably separates ICI-AKI from other causes and biopsy remains the gold standard; starting glucocorticoids within 3 days of diagnosis is associated with more kidney recovery; recurrence after rechallenge is under 20%, and the panel supports cautious rechallenge in selected patients.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: checkpoint inhibitor nephritis; ICI-associated acute kidney injury; ICI-AKI; immune-related acute interstitial nephritis; checkpoint inhibitor tubulointerstitial nephritis; immunotherapy kidney damage
- Tags: protocol; irae; nephrology

## Connected records

- protocols: [Baseline tests and monitoring before and during checkpoint inhibitor treatment](https://onco.cc/protocols/checkpoint-inhibitor-baseline-and-monitoring/), [Restarting a checkpoint inhibitor after an immune-related side effect](https://onco.cc/protocols/irae-rechallenge/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Avelumab](https://onco.cc/drugs/avelumab/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Society for Immunotherapy of Cancer](https://onco.cc/institutions/sitc/)
- terms: [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Rechallenge and retreatment](https://onco.cc/terms/rechallenge/)
- key papers: [ASCO 2021 guideline: how to recognise and manage the immune-related side effects of checkpoint inhibitors](https://onco.cc/key-papers/paper-asco-irae-guideline-jco-2021/)

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