Checkpoint Inhibitor AKI Beyond AIN — ESENeph MCQ

Correct answer: B — Withhold nivolumab and evaluate immune nephritis and competing AKI causes

The best answer is “Withhold nivolumab and evaluate immune nephritis and competing AKI causes”. Checkpoint-associated AIN is common but not the only lesion. Severity, urinalysis, concurrent medicines, serology and sometimes biopsy determine whether glucocorticoids are appropriate. “Review medicines and evaluate common haemodynamic or obstructive AKI causes” is less appropriate because PPIs, NSAIDs, antibiotics, obstruction, sepsis and volume changes remain important “Continue nivolumab while investigating a transient isolated creatinine change” is less appropriate because severity-based interruption and investigation should occur earlier “Investigate glomerular disease when urine findings suggest glomerular injury” is less appropriate because the sediment is nonspecific and further evaluation is needed “Consider checkpoint toxicity alongside other causes of acute kidney injury” is less appropriate because immune-related renal dysfunction is recognized in the product information

Reference: Opdivo Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/6888/smpc