免疫检查点抑制剂相关肾脏不良反应的临床诊治建议

Clinical Diagnosis and Treatment Recommendation of Immune-related Adverse Renal Events Related to Immune Checkpoint Inhibitor

免疫检查点抑制剂(immuno-checkpoint inhibitors,ICIs)正越来越多地应用于临床肿瘤治疗,显著改善了患者预后。T细胞过度活化及相关信号通路的激活,可能引起药物相关的免疫相关不良反应(immune-related adverse effects,irAEs)。其中肾脏免疫相关不良反应相对罕见,但也存在严重甚至致命的副作用。本文分析ICIs免疫相关肾损伤的发病率、临床表现及肾脏病理表现,着重讨论诊断和治疗原则。因存在诸多继发因素须与ICIs免疫相关肾损伤相鉴别,必要时应行肾活检以决定重要药物的治疗决策。

Immune checkpoint inhibitors(ICIs)have been used more and more Increasingly in clinical oncology treatment,which has significantly improved the prognosis of cancer patients.Over-activation of T cells and related signaling pathways may cause immune-related adverse effects.Renal immune side-effects are relatively rare,but some of them are serious and fatal.This review analyses of the Incidence,clinical and pathological manifestations of ICIs-induced renal injury,and focuses on the differential diagnosis and treatment.Because there are many secondary factors that need to be differentiated from immune mechanism,renal biopsy should be performed if necessary to determine the important decision.