Abstract:

Immune checkpoint inhibitors （immune checkpoint inhibitors， ICIs）， as new anti-tumour drugs， have significantly improved the prognosis of tumour patients by blocking the endogenous immune inhibitory signals and activating the immune response of T cells against tumours. However， the immune-related adverse events （irAEs） they cause have become a significant concern. irAEs can affect multiple organ systems， including the kidneys.Among these， immune checkpoint inhibitor-associated acute kidney injury （ICI-AKI） represents the most common renal toxicity manifestation. The most common pathological type is acute interstitial nephritis （AIN）. Non-AIN types， such as glomerular diseases and thrombotic microangiopathy， can also occur. The pathogenesis of ICI-AKI is complex， involving immune tolerance imbalance， abnormal activation of autoreactive T cells， autoantibody production， and inflammatory cytokines. ICI-AKI typically responds well to early corticosteroid therapy， with most patients achieving partial or complete renal recovery. Therefore， the timely evaluation， precise diagnosis， and standardized management of suspected cases hold crucial clinical value. A deep understanding of the clinical and pathological features and immunological mechanisms of ICI-related renal injury is the key to optimizing early identification， accurate diagnosis， and effective management. This review aims to systematically summarize the key pathological findings of current ICI-related kidney injury and deeply explore its immunological mechanisms of occurrence and development， providing theoretical basis and guidance for clinical practice.

Key words: immune checkpoint inhibitors, immune-related adverse events, acute kidney injury, nephrotoxicity, pathological type