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As early as the 18th century, physicians noticed that some cancer patients went into remission after developing fevers from infections. This led to the idea that the immune system, which protects from infection, might also fight cancer. What is now known as “immunotherapy” is a treatment that targets the immune system to recognize and eradicate cancer cells. Modern immunotherapy has focused on “checkpoint” proteins, such as cytotoxic T-lymphocyte-associated-protein-4 (CTLA-4) and programmed death-1 protein (PD-1), which are receptors on the surface of immune cells that act like a brake, or checkpoint, preventing the development of autoimmunity.1 The CTLA-4 receptor has homology to the T-cell activator co-stimulatory molecule CD28 and prevents T-cell activation by outcompeting CD28 for its ligand, the B7 receptor on antigen presenting cells (APCs).2 Likewise, binding of PD-1 with programmed death ligand 1 (PD-L1) — a protein expressed by immune, endothelial, and neoplastic cells — results in T-cell anergy.3 In both cases, an unwanted inflammatory response is suppressed.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Recognize the spectrum of renal toxicities associated with immune checkpoint inhibitors
  • Improve their diagnostic skill for identifying ATIN associated with immune checkpoint inhibitors
  • Improve their management of ATIN associated with immune checkpoint inhibitors

Reading Resources:

  1. Wanchoo R, Karam S, Uppal NN, et al. Adverse Renal Effects of Immune Checkpoint Inhibitors: A Narrative Review. Am J Nephrol. 2017;45(2):160-169.
  2. Cortazar FB, Marrone KA, Troxell ML, et al. Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors. Kidney Int. 2016;90(3):638-647.
  3. Nishimura H, Nose M, Hiai H, Minato N, Honjo T. Development of lupus-like autoimmune diseases by disruption of the PD-1 gene encoding an ITIM motif-carrying immunoreceptor. Immunity. 1999;11(2):141-151.
  4. Shirali AC, Perazella MA, Gettinger S. Association of Acute Interstitial Nephritis With Programmed Cell Death 1 Inhibitor Therapy in Lung Cancer Patients. Am J Kidney Dis. 2016;68(2):287-291.
  5. Spain L, Diem S, Larkin J. Management of toxicities of immune checkpoint inhibitors. Cancer Treat Rev. 2016;44:51-60.


Drs. Ong and Rondon-Berrios has reported no relevant relationships with any entities producing health care goods or services.

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 8/22/2017 | Last Modified On: 8/22/2017 | Expires: 8/22/2018

This course has been expired.