Rituximab for the treatment of immune checkpoint inhibitor–induced glomerulonephritis
Bibliographic record
Abstract
ABSTRACT Background Among patients receiving immune checkpoint inhibitor (ICI) therapy, the most common renal immune-related adverse event is interstitial nephritis, which is caused by severe T-cell infiltration and is typically responsive to steroids; although rarer, autoimmune induction in the kidney has also been reported. There is a paucity of data regarding ICI-induced autoimmune disease in the kidney and the challenges associated with continuing ICI therapy. Here, we present a single center case series of ICI-induced glomerulonephritis with data on treatment rechallenge. Methods We retrospectively reviewed 241 patients who underwent kidney biopsies at our institution between 2015 and 2024 and identified those who had non-vasculitis-associated glomerulonephritis after ICI therapy. Demographics, renal toxicity, renal response, disease response, and overall survival data were extracted from the patients’ medical records. We defined renal response based on creatinine and proteinuria using KDIGO guidelines. We also performed a literature review to identify published cases of ICI-induced glomerulonephritis. Differences between treatment groups were assessed with a two-sided, two-sample t-test and Wilcoxon test or with a chi-square test, as appropriate. Results Among 241 kidney biopsies we identified 16 patients with non-vasculitic GN, eight received rituximab with or without corticosteroids, and eight received corticosteroids only, for ICI-induced glomerulonephritis. The median proteinuria grades in the rituximab and corticosteroid groups were 3 and 1, respectively. The median corticosteroid treatment duration in the rituximab group (2.5 weeks) was shorter than that in the corticosteroid group (8 weeks). In the rituximab group, 75% of patients underwent ICI rechallenge and had no proteinuria relapse. Patients who received rituximab had better change in proteinuria response than those who received corticosteroids (P value = .029). Among the 42 patients we identified from the literature review, renal response did not differ significantly between the 10 who received rituximab and the 32 who did not. Conclusion Use of Rituximab in treatment of ICI-induced GN is an attractive option to reduce steroids exposure allowing continued ICI treatment for overall improved renal outcome. Clinical trials to evaluate these findings are needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".