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Clinical recommendations on diagnosis and treatment of immune checkpoint inhibitor-induced renal immune-related adverse events.

免疫检查点抑制剂引起的肾脏免疫相关不良事件诊治的临床建议。

  • 影响因子:2.17
  • DOI:10.1111/1759-7714.13405
  • 作者列表:"Zheng K","Qiu W","Wang H","Si X","Zhang X","Zhang L","Li X
  • 发表时间:2020-03-30
Abstract

:Immune checkpoint inhibitors (ICIs) are nowadays widely used in clinical oncology treatment, and significantly improve the prognosis of cancer patients. However, overactivation of T cells and related signaling pathways caused by ICIs can also induce immune-related adverse effects (irAEs). Renal immune side-effects are relatively rare, but some are serious and fatal. Acute kidney injury (AKI), diagnosed mainly by percentage increases in serum creatinine (sCr), is the most common clinical manifestation, while acute tubulointerstitial nephritis (ATIN) is the main cause of ICI-related AKI. Urinalysis analysis and sediment evaluation, 24 hour urine protein and sCr are helpful in screening and monitoring renal irAEs. Multiple potential causes for AKI are involved during cancer therapy, and should be differentiated from the immune mechanisms of ICIs. Under these circumstances, a renal biopsy should be considered which is essential for clinical decision-making. Steroids are an effective treatment option for renal irAEs. Most patients who experience ICI-related ATIN achieve a partial or complete renal recovery with prompt diagnosis and treatment. Multidisciplinary collaborations of different specialists will improve the effectiveness and outcome in the management of ICI irAEs.

摘要

免疫检查点抑制剂 (Immune checkpoint inhibitors,ICIs) 目前广泛应用于临床肿瘤治疗,显著改善肿瘤患者的预后。然而,ICIs 引起的 T 细胞和相关信号通路的过度激活也可诱导免疫相关不良反应 (irAEs)。肾免疫副作用相对少见,但有些是严重和致命的。急性肾损伤 (AKI) 是最常见的临床表现,主要通过血清肌酐 (sCr) 百分比升高来诊断,而急性肾小管间质性肾炎 (ATIN) 是 ICI 相关 AKI 的主要病因。尿液分析和沉渣评价、 24 小时尿蛋白定量和 sCr 有助于筛查和监测肾脏疾病。在癌症治疗过程中,AKI 的多种潜在病因参与其中,应与 ICIs 的免疫机制相鉴别。在这种情况下,应考虑肾活检,这对临床决策至关重要。类固醇是一种有效的治疗肾脏 irAEs 的选择。大多数经历 ICI 相关 ATIN 的患者在及时诊断和治疗的情况下达到部分或完全肾脏恢复。不同专家的多学科合作将提高 ICI irAEs 管理的有效性和结果。

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