Management of Immune-Related Adverse Event-Associated Urinary Tract Inflammation (irAE-UTI)

Background: irAEs that show as urinary tract inflammation are very rare, with limited understanding. Methods: We analyzed 10 irAE-UTI cases and 18 IirAE-associated acute kidney injury(ICI-AKI) cases as controls. Results: The UTI group exhibited urinary tract irritation symptoms, with a higher proportion of patients exhibiting positive urine protein and WBC(P<0.05). Imaging found roughened and thickened bladder wall. Bladder biopsies revealed PD-1-/PD-L1-positive lymphocytes infiltration. Concurrent AKI in UTI patients correlated with higher AKI grades than in AKI group (P<0.05). UTI group received lower cumulative steroid doses showed improvements in urinary tract irritation symptoms and renal function without secondary infections. Conclusion: Urinary irritation symptoms, elevated urine WBC with negative cultures, and imaging evidence of UTI can diagnose irAE-UTI. - ICI-UTI(n=10) ICI-AKI(n=18) P-value irAE-AKI grade(n) 6 18 0.038 0 4 0 1 0 2 2 3 9 3 1 5 4 2 2 Urinalysis(n) protein(+) 5 6 0.012 WBC(+) 7 2 0.003 BLD(+) 4 5 0.677 Total steroid dose(median,mg) 1470 3350 0.014 Duration of steroid(d) 36 76 0.003 Kidney complete remission 6 10 0.162