Clinical Implications of Striated Nephrogram in Patients Receiving Immune Checkpoint Inhibitors for Cancer

Acute interstitial nephritis (AIN) is a common side effect of immune checkpoint inhibitor (ICI) therapy and develops in 2-5% of patients.1,2 Prompt recognition and differentiation of ICI-AIN from other causes of AKI are crucial for continuing ICIs.3 ICI-AIN is difficult to diagnose without a kidney biopsy, and there is an unmet need for non-invasive diagnostic markers.1 Recent studies suggest that cross-sectional imaging findings may be abnormal in patients with ICI-AIN.4,5,6 In our clinical experience, patients receiving ICIs may develop a ‘striated nephrogram’ (alternating bands of high and low contrast attenuation extending through corticomedullary layers of the kidney) on contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) studies performed as part of routine cancer surveillance (Figure 1).