Kidney Complications of Immune Checkpoint Inhibitors: A Review

Am J Kidney Dis. 2019 Oct;74(4):529-537. doi: 10.1053/j.ajkd.2019.03.433. Epub 2019 Jul 11.


Immunologic control of malignancy has long been recognized as an important determinant of disease progression. Recent advances in immunology have led to the focus on several mechanisms that can be targeted to achieve tumor suppression. In particular, checkpoint inhibition has evolved in less than a decade to become one of the most important strategies in cancer therapy, with a meaningful improvement in patient survival. Six agents have been approved for clinical use to date and many more are in the industry pipeline. The spectrum of malignancies responsive to immunotherapy ranges from advanced melanoma, for which the first immune checkpoint inhibitor ipilimumab was approved, to Hodgkin lymphoma, non-small cell lung cancer, renal cell carcinoma, and others. Notwithstanding its clinical benefits, checkpoint inhibition carries a risk for significant off-target toxicity stemming from the immune system activation. In this review, we discuss general principles of checkpoint inhibition, mechanisms of toxicity, and kidney complications of the treatment and propose diagnostic and treatment strategies when kidney injury occurs.

Keywords: Acute kidney injury (AKI); cancer immunotherapy; checkpoint inhibitor; corticosteroids; cytotoxic T-lymphocyte associated protein 4 inhibitor; immune-related adverse effect (irAE); immunotherapy; interstitial nephritis; onconephrology; programmed cell death protein 1 inhibitor; renal function; review.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Aged
  • Antineoplastic Agents, Immunological / adverse effects*
  • Antineoplastic Agents, Immunological / immunology*
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / drug therapy
  • Carcinoma, Non-Small-Cell Lung / immunology
  • Humans
  • Immunotherapy / adverse effects*
  • Immunotherapy / trends
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / immunology*
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / immunology
  • Male


  • Antineoplastic Agents, Immunological