{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T20:02:33Z","timestamp":1785268953472,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Immune checkpoint inhibitors (ICIs) have significantly modified the management of metastatic cancers; however, their nephrotoxic potential remains underappreciated. While acute kidney injury (AKI) is a known immune-related adverse event, the subacute spectrum of kidney injury\u2014termed acute kidney disease (AKD)\u2014has not been adequately explored in this setting. Methods: We conducted a retrospective cohort study in 226 adult patients with metastatic solid tumors who received ICIs between 2017 and 2023 at a single tertiary care center. AKD was defined according to the 2024 \u201cKidney Disease: Improving Global Outcomes\u201d (KDIGO) criteria. Multivariable logistic regression was used to identify predictors of AKD. Results: AKD occurred in 46 patients (20.4%) within 90 days of ICI initiation, with 16 (7.1%) experiencing persistent dysfunction beyond 30 days. Independent predictors of AKD included higher body surface area (OR 8.17, p = 0.03) and baseline use of nonsteroidal anti-inflammatory drugs (OR 29.74, p = 0.014). Baseline antibiotics showed a trend toward association (p = 0.054). Concurrent chemotherapy was associated with a trend toward protection. The predictive model showed good discrimination (AUC 0.778). No significant differences in other grade \u22652 immune-related adverse events were observed between the AKD and non-AKD groups. Conclusions: AKD is a frequent and underrecognized renal complication in patients receiving ICIs, with implications for both renal and oncological outcomes. Identifying high-risk patients and integrating longitudinal renal monitoring into immunotherapy care pathways may improve safety and treatment continuity.<\/jats:p>","DOI":"10.3390\/cancers17132090","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T03:39:26Z","timestamp":1750649966000},"page":"2090","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Immunotherapy-Associated Renal Dysfunction in Metastatic Cancer: An Emerging Challenge in Onco-Nephrology"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4205-8959","authenticated-orcid":false,"given":"Francesco","family":"Trevisani","sequence":"first","affiliation":[{"name":"URI\u2014Urological Research Institute, Department of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8311-5409","authenticated-orcid":false,"given":"Andrea","family":"Angioi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, Piazzale Alessandro Ricchi 1, 09047 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5435-1218","authenticated-orcid":false,"given":"Michele","family":"Ghidini","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Floris","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, Piazzale Alessandro Ricchi 1, 09047 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7043-2170","authenticated-orcid":false,"given":"Davide","family":"Izzo","sequence":"additional","affiliation":[{"name":"Postgraduate School of Medical Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4892-7775","authenticated-orcid":false,"given":"Renato Maria","family":"Marsicano","sequence":"additional","affiliation":[{"name":"Postgraduate School of Medical Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8605-4290","authenticated-orcid":false,"given":"Nerina","family":"Denaro","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Tomasello","sequence":"additional","affiliation":[{"name":"Oncology Unit, ASST Crema, Largo U. Dossena 2, 26013 Crema, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7359-5410","authenticated-orcid":false,"given":"Ornella","family":"Garrone","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e192535","DOI":"10.1001\/jamanetworkopen.2019.2535","article-title":"Estimation of the Percentage of US Patients with Cancer Who Are Eligible for and Respond to Checkpoint Inhibitor Immunotherapy Drugs","volume":"2","author":"Haslam","year":"2019","journal-title":"JAMA Netw. 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