Acute tubulointerstitial nephritis induced by checkpoint inhibitors versus classical acute tubulointerstitial nephritis : are they the same disease?
Draibe, Juliana (Hospital Universitari de Bellvitge)
García-Carro, Clara (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Martinez-Valenzuela, Laura (Hospital Universitari de Bellvitge)
Agraz Pamplona, Irene (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Fulladosa, Xavier (Hospital Universitari de Bellvitge)
Bolufer Cardona, Mónica (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Tango, Ariel (Hospital Universitari de Bellvitge)
Torras, Joan (Universitat de Barcelona)
Soler, María José (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	The incidence of acute tubulointerstitial nephritis (ATIN) related to drugs has dramatically increased over recent years. A new subtype of ATIN, apparently different from classical drug-related ATIN, has emerged that has been related to the administration of immune checkpoint inhibitors (ICIs). We investigated these differences between ICI-related ATIN (ICI ATIN) and non-ICI-related ATIN in terms of clinical features, response to treatment with steroids and the evolution of kidney function. A total of 47 patients diagnosed with ATIN from two centres were recruited. Of these, 13 patients presented with ATIN during ICI treatment and 34 were diagnosed with ATIN attributed to other drugs. The main demographic, clinical and analytical variables such as gender, age and current medication were recorded. The type of malignancy, oncological treatment, ICI dose and presence of extrarenal immune-related adverse events were also reviewed. Renal biopsy diagnosis, time to drug withdrawal and ATIN-specific treatment, as well as laboratory data during follow-up, were also studied. Patients diagnosed with ICI ATIN presented with lower creatinine (ICI ATIN 3. 8 ± 1. 03 versus classical ATIN 5. 98 ± 4. 15 mg/dL, P = 0. 007) at diagnosis and higher urinary leucocyte counts (ICI ATIN 263. 2 ± 418. 04 versus classical ATIN 133. 55 ± 284. 62, P = 0. 048) compared with patients with non-ICI-related ATIN. Time from initiation of the culprit drug to ATIN diagnosis was longer in patients with ICI ATIN than in those with classical ATIN (197. 07 ± 184. 99 versus 114. 4 ± 352. 16 days, P = 0. 006). In addition, during follow-up, the slope of decreasing creatinine over time was lower for ICI ATIN compared with non-ICI-related ATIN. In this study, we analysed differences between ICI ATIN and classical ATIN. We found that patients with ICI ATIN presented with a larger latency period after culprit drug initiation, milder acute kidney injury and slower creatinine amelioration compared with those with classical ATIN. These results may, in part, be ascribed to potential differences in the pathological mechanisms involved in ATIN development, suggesting that ICI and classical ATIN may be different diseases with similar renal histologies.
Ajuts:	Instituto de Salud Carlos III RD016-0009
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute kidney injury ; Acute tubular nephritis ; Immune checkpoint inhibitors ; Kidney biopsy ; Steroid therapy
Publicat a:	Clinical Kidney Journal, Vol. 14 (may 2020) , p. 884-890, ISSN 2048-8513

DOI: 10.1093/ckj/sfaa027
PMID: 33777371

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