免疫检查点抑制剂相关肾损伤

免疫检查点抑制剂已被批准用于多种肿瘤的治疗,在杀伤肿瘤细胞的同时也可造成肾脏损伤,影响患者的预后.免疫检查点抑制剂损伤肾脏的机制包括诱导产生自身抗体、与正常组织上的受体相结合触发免疫反应、新生或者反应性T细胞与肾组织发生交叉反应、诱导潜伏状态的药物特异性T细胞再活化、促使T细胞释放炎症因子和趋化因子等,临床主要表现为无...

The immune checkpoint inhibitors related kidney injury

Immune checkpoint inhibitors(ICIS) have been approved in the treatment of a series of malignant tumors,and kidney injury is an uncommon adverse reaction of this breakthrough innovation,which affects the prognosis of patients significantly.The mechanisms underlying ICIs-induced kidney injury may include development of autoantibodies that are pathogenic to the kidney,induction of immune reaction against the tissues which express checkpoint receptors,formation of new or reactivated T cells against tumor antigens that crossreact with off-target kidney tissues,reactivation of drug-specific T cells through ICIs induced loss of tolerance and over expression of proinflammatory cytokines.Acute kidney injury without oliguria or hypertension is the most common clinical manifestation of ICIs-induced kidney injury,and acute tubular interstitial injury is the major pathological changes.However,a variety of glomerular lesions can be observed,together with a different degree of urinarl abnormality.Kidney biopsy is helpful in confirm etiology of the kidney injury of patients receiving ICIs,and whether therapy should be discontinued.The usage of glucocorticoids depend on the graduation of acute kidney injury.In this review,we will discuss mechanisms, clinical manifestations, pathological changes and treatment strategy of ICIs-induced kidney injury,in order to improve management of this kind of complication and outcome of the patients.