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Renal toxicity, although less common, represents a clinically important and often underrecognized complication with substantial morbidity and health care costs. The pathogenesis of immune-related acute kidney injury (irAKI) is thought to be primarily immune-mediated, driven by unchecked T-cell activation and loss of peripheral tolerance within the kidney. Clinically, irAKI is often asymptomatic and often detected incidentally as a rise in serum creatinine. Diagnosis is largely one of exclusion, requiring careful evaluation for alternative causes of AKI common in oncology patients. Management is guided by AKI severity and revolves around the temporary or permanent discontinuation of ICIs, prompt initiation of corticosteroids, and additional immunosuppressive therapy reserved for refractory cases. This review summarizes current evidence on ICI-associated AKI and highlights areas where further prospective research is needed to optimize both renal and oncologic outcomes.<\/jats:p>","DOI":"10.1200\/op-26-00282","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:59:17Z","timestamp":1787860757000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Immune Checkpoint Inhibitor\u2013Associated Acute Kidney Injury"],"prefix":"10.1200","author":[{"given":"Sree Manasa","family":"Puttamreddy","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Alabama, Montgomery, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumna","family":"Khalid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Alabama, Montgomery, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketki","family":"Tendulkar","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3724-2671","authenticated-orcid":true,"given":"Apar Kishor","family":"Ganti","sequence":"additional","affiliation":[{"name":"Division of Oncology-Hematology, VA Nebraska Western Iowa Health Care System and Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE"},{"name":"Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-17670-y"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.4103\/apjon.apjon_4_17"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez418"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.04.008"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2019-000467"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfy105"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/CJI.0000000000000338"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.03.433"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc11454"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.259"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.6.609"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-018-0478-8"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.624547"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfae184"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2019.06.001"},{"key":"e_1_3_5_17_2","doi-asserted-by":"crossref","first-page":"e05445","DOI":"10.1002\/advs.202505445","article-title":"Resident macrophage-orchestrated immune and fibroblast interactions in immune checkpoint inhibitor-associated nephrotoxicity","volume":"12","author":"Ma Y","year":"2025","unstructured":"Ma Y, Chen Y, Yao Q, et al: Resident macrophage-orchestrated immune and fibroblast interactions in immune checkpoint inhibitor-associated nephrotoxicity. 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