ICPI-Associated Acute Interstitial Nephritis When Corticosteroid Therapy Fails to Restore Kidney Function

Immune checkpoint inhibitor (ICPI) therapy can trigger acute tubulointerstitial nephritis (ATIN) as an immune-related adverse event. When first-line corticosteroid treatment does not result in adequate renal recovery, a defined next-line approach is required.

Clinical Scenario

Acute tubulointerstitial nephritis arising as a consequence of ICPI therapy. ATIN associated with ICPIs typically develops approximately 14 weeks (range: 6–37 weeks) after the initiation of treatment.

Previous Treatment — Failure Condition

First-line management with corticosteroid therapy (oral prednisolone or prednisone) did not achieve improvement in kidney function — neither complete nor partial renal recovery was reached. This protocol defines the structured step taken after that failure.

Next-Line Approach (Partial Overview)

For corticosteroid-resistant ICPI-associated ATIN, a targeted biologic therapy has demonstrated benefit. The complete regimen — including agent selection, sequencing, and monitoring — is in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

ATIN associated with ICPIs typically develops approximately 14 weeks (range: 6–37 weeks) after the initiation of treatment.
Infliximab has been useful in corticosteroid resistant ICPI-associated ATIN.

DOI: 10.1016/j.ekir.2025.03.050

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