Immune checkpoint inhibitor-related acute kidney injury: A diagnostic and therapeutic challenge for nephrologists

Table 5 Recommendations for kidney biopsy and treatment of immune checkpoint inhibitor-related acute tubulointerstitial nephritis

Society/guideline	Biopsy recommendation	Treatment recommendation
American Society of Clinical Oncology, 2022[28]	Biopsy only if AKI is refractory to steroids or immunosuppression	Empiric treatment with steroids is reasonable if no alternate cause for AKI is identified
European Society of Medical Oncology, 2022[29]	Case-by-case decision after oncologist-nephrologist discussion	Empiric treatment with steroids is reasonable if no alternate cause for AKI is identified
National Comprehensive Cancer Network, 2019[30]	Consider biopsy for severe AKI (grade ≥ 3): Creatinine > 3 × baseline or > 4 mg/dL (353.68 μmol/L)	Nephrology consults for moderate AKI (grade 2): Creatinine > 2 × baseline
American Society of Onco-Nephrology, 2025[1]	Strongly recommends kidney biopsy for all KDIGO stage 2-3 AKI, unless absolute contraindication or clear alternate cause identified	Empiric steroids treatment is reasonable if biopsy is unavailable or contraindicated, and there is a high clinical suspicion of ICI-related ATIN to avoid > 3-day delay in starting treatment

AKI: Acute kidney injury; KDIGO: Kidney Disease Improving Global Outcomes; ICI: Immune checkpoint inhibitor; ATIN: Acute tubulointerstitial nephritis.