Thread by @ShrutiGkidney

*NEW ARTICLE*
What does a nephrologist need to know about immune checkpoint inhibitor-associated AKI (ICPi-AKI)?@DavidLeaf9 #Thread
my first #tweetorial with help from @kdjhaveri
jitc.bmj.com/content/9/10/e… (1/11)

Why does it matter? ICPi-AKI can lead to:
*Discontinuation of ICPi therapy
*Irreversible loss of kidney function
*Prolonged courses of immunosuppression (2/11)

We conducted a multicenter study of 429 patients with ICPi-AKI from 30 sites across 10 countries, along with 429 control patients who received ICPis contemporaneously but did not develop ICPi-AKI. This is the largest study to date on ICPi-AKI (3/11)

TIMING: ICPi-AKI developed at a median of 16 weeks (IQR 8-32) after ICPi initiation (4/11)

DIAGNOSIS: Urinary findings like leukocyte esterase, proteinuria, and hematuria were highly variable
Extrarenal immune-related adverse events (irAEs) occurred in 57% of patients
Among the 151 biopsied patients, 83% had ATIN (5/11)

RISK FACTORS: Lower baseline eGFR, PPI use, and prior or concomitant extrarenal irAEs were independent risk factors for ICPi-AKI (6/11)

TREATMENT/OUTCOMES: Early treatment with steroids (within 3 days) was associated with a greater likelihood of renal recovery (7/11)

RECHALLENGE: 121 patients were rechallenged, of whom only 16.5% had recurrent ICPi-AKI (8/11)

Our study is the largest to date, and generated important insights on ICPi-AKI, including the low risk of recurrent ICPi-AKI with ICPi rechallenge (9/11)

Many thanks to all our collaborators who made this study possible @nymurakami, @megsise, @kidneyKhanin, @renalmyeloma, @hofstrakidney, @renaghan1, @HerrmannMd, @onconeph, @kdjhaveri , @ClaraGCarro, @PepaSolerR and more! @jitcancer @ASNKidney @BWHKidney (10/11)

Visual abstract by @PabloGarciaMD summarizes these findings. Next step: we need more research on biomarkers of ICPi-AKI #immunotherapy @threadreaderapp #unroll (11/11)