Nephritis – Grade 2

Management escalation pathway

  • Withhold ICPI
  • Hydration and review creatinine in 48-72h; if not improving, discuss with nephrologist the need for biopsy and if attributed to irAE, initiate steroids (oral prednisolone 1mg/kg)
  • When returning to Grade 1, or baseline: restart ICPI might be discussed upon corticoid stop

Assessment and Investigations

  • Renal ultrasound +/- doppler to exclude obstructions or a clot
  • If proteinuria: 24h collection or UPCR
  • Advise patient to notify if oliguric


US: Ultra Sound
ULN: Upper Limit of Normal
ICPi: Immune Checkpoint Blockade Inhibition
UPCR: Urine Protein to Creatinine Ratio
ACPA: Anti Citrullinated Antibody
ANCA: Anti Neutrophil Cytoplasmic Antibody
CRP: C Reactive Protein
RF: Rheuma Factor