F18-FDG PET imaging as a diagnostic tool for immune checkpoint inhibitor–associated acute kidney injury

To the Editor: Immune checkpoint inhibitors (ICIs), anticancer agents that enhance antitumor response, can cause autoimmune toxicities, including ICI-associated acute kidney injury (ICI-AKI).The most common histopathologic lesion in patients with ICI-AKI is acute tubulointerstitial nephritis (ATIN); however, a definitive diagnosis of ATIN requires a kidney biopsy (1).This represents a frequently encountered clinical challenge for providers, as AKI is very common among cancer patients, many of whom have contraindications to kidney biopsy (e.g., solitary kidney, therapeutic anticoagulation).Accordingly, noninvasive methods of diagnosing ICI-AKI are urgently needed, as treatment involves glucocorticoids and discontinuation of potentially life-saving immunotherapy.Case reports and one case series explored the utility of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography-computed tomography (F18-FDG PET-CT) for diagnosing ICI-AKI and reported mixed findings (2, 3); however, these studies did not have clear inclusion and exclusion criteria to carefully phenotype the patients, did not use rigorous techniques to minimize sampling error, and, most importantly, in some cases did not include a control group.We sought to address these key knowledge gaps and define the role of F18-FDG PET-CT in diagnosing ICI-AKI.We used data from a retrospective, multicenter cohort study of 429 patients with ICI-AKI treated at 30 sites across 10 countries (1).Patients were diagnosed with ICI-AKI between 2012 and 2023 and had either biopsy-proven or clinically adjudicated ICI-AKI (Supplemental Table 1; []

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Publication Details

Journal
Journal of Clinical Investigation
Published
2024-08-08
DOI
https://doi.org/10.1172/jci182275
Citations
14
Primary Topic
Cancer Immunotherapy and Biomarkers
Type
article
Field-Weighted Citation Impact
3.96
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article

F18-FDG PET imaging as a diagnostic tool for immune checkpoint inhibitor–associated acute kidney injury

Raymond K. Hsu, Mindy X. Wang, Michael S. Bold, Pedram Heidari et al.
14 citations
Journal of Clinical Investigation
Cancer Immunotherapy and Biomarkers
3.96
article

F18-FDG PET imaging as a diagnostic tool for immune checkpoint inhibitor–associated acute kidney injury

Raymond K. Hsu, Mindy X. Wang, Michael S. Bold, Pedram Heidari, Miguel Hernandez Pampaloni, Aleksandra A. Krokhmal, Ben Sprangers, Heiko M. Schöder, Yael Eshet, David E. Leaf, Muhammad O. Awiwi, Norbert Avril, Zain Mithani, Clara García-Carro, Kerry L. Reynolds, Wai Lun Will Pak, Sophia L. Wells, Christophe M. Deroose, Sugama Chicklore, Ala Abudayyeh, Meghan E. Sise, Shruti Gupta, Russ A. Kuker, Meghan Lee, Heather A. Jacene, Ilya Glezerman, Sujal I. Shah, Pazit Beckerman, Arash Rashidi, Marlies Ostermann, María José Soler, Vicki Donley, Kevin L. Chen, Harish Seethapathy, Sudhir Bhimaniya, Raad B. Chowdhury, Olivia Green‐Lingren, Sarah Allison Kaunfer, Sandra M. Herrmann, Michael Daniel Weintraub, Jessica L. Ortega
article en
14 citations

Abstract

To the Editor: Immune checkpoint inhibitors (ICIs), anticancer agents that enhance antitumor response, can cause autoimmune toxicities, including ICI-associated acute kidney injury (ICI-AKI).The most common histopathologic lesion in patients with ICI-AKI is acute tubulointerstitial nephritis (ATIN); however, a definitive diagnosis of ATIN requires a kidney biopsy (1).This represents a frequently encountered clinical challenge for providers, as AKI is very common among cancer patients, many of whom have contraindications to kidney biopsy (e.g., solitary kidney, therapeutic anticoagulation).Accordingly, noninvasive methods of diagnosing ICI-AKI are urgently needed, as treatment involves glucocorticoids and discontinuation of potentially life-saving immunotherapy.Case reports and one case series explored the utility of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography-computed tomography (F18-FDG PET-CT) for diagnosing ICI-AKI and reported mixed findings (2, 3); however, these studies did not have clear inclusion and exclusion criteria to carefully phenotype the patients, did not use rigorous techniques to minimize sampling error, and, most importantly, in some cases did not include a control group.We sought to address these key knowledge gaps and define the role of F18-FDG PET-CT in diagnosing ICI-AKI.We used data from a retrospective, multicenter cohort study of 429 patients with ICI-AKI treated at 30 sites across 10 countries (1).Patients were diagnosed with ICI-AKI between 2012 and 2023 and had either biopsy-proven or clinically adjudicated ICI-AKI (Supplemental Table 1; []

Journal of Clinical InvestigationVol. 134(18)
Brigham and Women's Hospital (US), St Thomas' Hospital (GB), Mayo Clinic (US), Memorial Sloan Kettering Cancer Center (US), The University of Texas MD Anderson Cancer Center (US), Harvard University (US), University of Miami (US), Tel Aviv University (IL), University of California, San Francisco (US), King's College London (GB), Cornell University (US), University Hospitals of Cleveland (US), Sheba Medical Center (IL), University of California System (US), Hospital Clínico San Carlos (ES), Massachusetts General Hospital (US), Pediatric Nephrology of Alabama (US), Dana-Farber Cancer Institute (US), University of Miami Hospital (US), Ziekenhuis Oost-Limburg (BE), Hasselt University (BE), The University of Texas Health Science Center at Houston (US), KU Leuven (BE)
Good health and well-being
Openalex Percentile: Top 5%
Cancer Immunotherapy and Biomarkers
3.96
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