Clinical features: variable and often long latency. Almost a third of patient have bland urinalyses! #irAE2021 #Nephtwitter #IO 
By far the most common kidney pathology is acute tubulo-interstitial nephritis! #irAE2021 #Nephtwitter #IO
Other immune pathology have certainly been described and the list keeps expanding! #irAE2021 #Nephtwitter #IO
But not all pathology reported is immune!!! ...Alot of ATN has been described as well!! #irAE2021 #Nephtwitter #IO
PPI use and baseline CKD are risk factors for ICPi related nephritis! PPI use is a potentially modifiable risk factor!! #irAE2021 #Nephtwitter #IO
After careful evaluation for alternate pathology, if none is identified, empiric steroid therapy is appropriate. Higher dose and longer taper for more severe cases! #irAE2021 #Nephtwitter #IO
If there are no contraindications for a kidney biopsy, we pursue a biopsy in select cases! #irAE2021 #Nephtwitter #IO
Additional immunosuppression is sometimes needed. Evidence lacking for a specific agent! #irAE2021 #Nephtwitter #IO
So how do these patients do...do they recover? Fortunately yes! Most patients achieve a complete or partial recovery! #irAE2021 #Nephtwitter #IO
This is fortunate as it seems like achieving a good renal response carries a survival advantage! #irAE2021 #Nephtwitter #IO
So your patient with a grade 3/4 kidney toxicity (stage 3 KDIGO AKI) achieves a partial kidney response! Would you re-challenge with iCPI? #irAE2021 #Nephtwitter #IO
Limited data...however based on available data, most re-challenged patients appear to do well without recurrence. #irAE2021 #Nephtwitter #IO
One word about kidney transplant patients on ICPi: early and severe graft rejection in close to 50% with almost 80% graft loss. #irAE2021 #Nephtwitter #IO
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