Javaid MM, Tonkin-Hill G, Klein M. Immune checkpoint inhibitor-related acute kidney injury: A diagnostic and therapeutic challenge for nephrologists. World J Nephrol 2026; 15(1): 114239 [DOI: 10.5527/wjn.v15.i1.114239]
Corresponding Author of This Article
Muhammad M Javaid, Affiliate Associate Professor, Consultant, FASN, FRACP, FRCP, Department of Medicine, South West Healthcare, 25 Ryot Street, Warrnambool 3280, Victoria, Australia. mmjavaid@doctors.org.uk
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 25, 2026 (publication date) through Mar 14, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Nephrology
ISSN
2220-6124
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Javaid MM, Tonkin-Hill G, Klein M. Immune checkpoint inhibitor-related acute kidney injury: A diagnostic and therapeutic challenge for nephrologists. World J Nephrol 2026; 15(1): 114239 [DOI: 10.5527/wjn.v15.i1.114239]
World J Nephrol. Mar 25, 2026; 15(1): 114239 Published online Mar 25, 2026. doi: 10.5527/wjn.v15.i1.114239
Immune checkpoint inhibitor-related acute kidney injury: A diagnostic and therapeutic challenge for nephrologists
Muhammad M Javaid, Gina Tonkin-Hill, Martin Klein
Muhammad M Javaid, Gina Tonkin-Hill, Martin Klein, Department of Medicine, South West Healthcare, Warrnambool 3280, Victoria, Australia
Muhammad M Javaid, Martin Klein, Deakin Medical School, Deakin University, Warrnambool 3280, Victoria, Australia
Muhammad M Javaid, Rural Health Mildura, Monash University, Melbourne 3000, Victoria, Australia
Author contributions: Javaid MM designed the review article, wrote the first draft, replied to the reviewers’ comments; Javaid MM, Tonkin-Hill G, and Klein M performed the literature search, and critically reviewed and revised the manuscript; Tonkin-Hill G made the tables and figures. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Muhammad M Javaid, Affiliate Associate Professor, Consultant, FASN, FRACP, FRCP, Department of Medicine, South West Healthcare, 25 Ryot Street, Warrnambool 3280, Victoria, Australia. mmjavaid@doctors.org.uk
Received: September 15, 2025 Revised: October 25, 2025 Accepted: January 7, 2026 Published online: March 25, 2026 Processing time: 181 Days and 0.5 Hours
Abstract
Immune checkpoint inhibitor (ICI)-related acute kidney injury (AKI) is a rare but serious complication in cancer patients. The presenting features are often non-specific, making it difficult to distinguish from other, more commonly encountered pre-renal and post-renal causes. However, a precise diagnosis is imperative to instigate a proper management plan and minimise the inappropriate use of immunosuppression, which might have serious consequences for such sick patients. The indications for ICI use have increased over the years, and they will likely become the standard of care for many more difficult-to-treat malignancies in the future. Nephrologists will become increasingly involved in the management of such patients, especially in challenging decisions regarding withholding and restarting the treatment and starting immunosuppression. The current guidelines are ambiguous regarding the diagnostic workup and differ in their recommendations about the utility of a kidney biopsy, withholding the offending agent, and rechallenging with ICIs once AKI has resolved. This article tends to explore these questions and provides an update on ICI-related AKI, summarising the information from recently published clinical trials, meta-analyses, and systematic reviews. It also examines the recommendations of the major international guidelines, provides practical information for the practising nephrologists and identifies the gaps in the current knowledge to help future research.
Core Tip: Immune-mediated acute kidney injury is rare in cancer patients treated with immune checkpoint inhibitors. The presenting features are non-specific, making it difficult to distinguish from other more commonly encountered pre-renal and post-renal causes. However, a precise diagnosis is imperative for instigating appropriate management plan. Attention to the presence of risk factors and other associated features can guide further investigations. Confirmation of diagnosis with a kidney biopsy can minimise the risk of inappropriate exposure to immunosuppression in already seriously unwell patient.
