# Urgent considerations on renal immune-related adverse events in oncology practice

## TL;DR

This paper reviews how immune therapy can cause kidney problems in cancer patients and highlights important considerations for managing these issues.

## Contribution

The paper systematically examines the causes, biomarkers, and management of kidney-related immune side effects in cancer patients.

## Key findings

- Renal irAEs often require treatment discontinuation and can worsen cancer outcomes.
- Genetic susceptibility and non-invasive biomarkers are important for managing renal irAEs.
- Targeted immunotherapy may improve both kidney health and cancer survival.

## Abstract

In recent years, immune checkpoint inhibitors (ICIs) have emerged as a critical component of hematological malignancies and solid malignant tumors therapy. However, clinical practice has revealed that these agents may induce immune-related adverse events (irAEs). Notably, renal irAEs stands out as a significant clinical concern, frequently necessitating treatment discontinuation and thereby enabling tumor progression. Renal irAEs constitutes a critical consideration for patients with cancer complicated by chronic kidney disease (CKD). This review systematically examines the immunologic pathogenesis of ICIs-induced renal disease, susceptibility genes, non-invasive biomarkers, and efficient intervention strategies. It further analyzes the critical considerations regarding renal irAEs that oncologists must address, based on real-world evidence from ICIs therapy in cancer patients with CKD, including those who are renal transplantation recipients or have end-stage renal disease (ESRD). Additionally, the promising targeted immunotherapy for malignant tumors is expected to improve both renal outcomes and survival prognosis in cancer patients.