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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Immune-Related Adverse Events for Renal Toxicities - Nephritis

    Grades severity of nephritis secondary to immune checkpoint inhibitor therapy.

    INSTRUCTIONS

    Use in adult patients with elevations in creatinine levels or symptoms suggesting nephritis while on treatment with immune checkpoint inhibitors.

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients with elevations in creatinine levels or symptoms suggesting nephritis that developed while on treatment with immune checkpoint inhibitors including agents against PD-1 (i.e. pembrolizumab, nivolumab), PD-L1 (i.e. atezolizumab, avelumab, durvalumab), or CTLA-4 (i.e. ipilimumab).

    • Immune checkpoint inhibitor (ICPi) nephritis should be suspected in patients with elevations in creatinine levels or symptoms suggesting nephritis while on treatment with immune checkpoint inhibitors.

    • Immune checkpoint inhibitor (ICPi) nephritis is an uncommon but potentially serious toxicity.

    • More frequently seen with combination treatment of more than one ICPi but is also an important adverse event caused by single agent ICPi.

    • ICPi therapy appears to be safe in patients with baseline renal impairment from nonimmune basis (i.e. prior nephrectomy, old age, hypertension).

    • Management of ICPi nephritis is based on the grade of nephritis.

    This tool aids in the decision of immune checkpoint inhibitor discontinuation, further diagnostic work-up and immunosuppressant treatment initiation.

    Creatinine level increase of >0.3 mg/dL; creatinine 1.5-2.0x over baseline
    Creatinine 2-3x above baseline
    Creatinine >3x baseline or >4.0 mg/dL; hospitalization indicated
    Life-threatening consequences; dialysis indicated

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Julie R. Brahmer

    About the Creator

    Julie R. Brahmer, MSc, MD, is the co-director of the upper aerodigestive department at Johns Hopkins Medicine in Baltimore, MD. She is also a professor of oncology at Johns Hopkins Medicine. Dr. Brahmer’s primary research is focused on treatment of lung cancer and mesothelioma.

    To view Dr. Julie R. Brahmer's publications, visit PubMed

    Are you Dr. Julie R. Brahmer? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Nazli Dizman, MD
    About the Creator
    Dr. Julie R. Brahmer
    Are you Dr. Julie R. Brahmer?
    Content Contributors
    • Nazli Dizman, MD