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ICI MCD Nephropathy — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyICI MCD NephropathySCE Medical Oncology

A 60-year-old woman on ICI develops acute kidney injury. Renal biopsy shows minimal change disease (MCD — podocyte foot process effacement on electron microscopy, no granulomata). How does this compare with the more common ATIN pattern of ICI nephritis?

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Correct answer: B — Immune-mediated minimal-change nephrotic syndrome treated initially with corticosteroids

Foot-process effacement with nephrotic syndrome and no immune deposits identifies checkpoint-associated minimal-change disease, generally treated with corticosteroids. Immune-mediated acute interstitial nephritis treated initially with corticosteroids: ATIN is the commoner checkpoint lesion but the biopsy here shows podocyte foot-process effacement. Immune-mediated membranous nephropathy treated initially with corticosteroids: membranous disease requires immune deposits and basement-membrane change. Immune-mediated thrombotic microangiopathy treated initially with plasma exchange: TMA requires endothelial injury and microangiopathic findings. Immune-mediated anti-GBM nephritis treated initially with plasma exchange: anti-GBM disease requires crescentic injury and linear IgG rather than minimal change.

Reference: Minimal-change disease associated with anti-PD-1 immunotherapy (Published June 2018): https://pmc.ncbi.nlm.nih.gov/articles/PMC6029341/; West of Scotland Cancer Network immune-related adverse-events guideline (Version 4.0, March 2024; review due March 2027): https://rightdecisions.scot.nhs.uk/media/b11eeh40/woscan-immunotherapy-iraes-guideline-v40.pdf