Nephritis – Grade 3

Management escalation pathway

  • Withhold ICPI
  • Admit patient for monitoring and fluid balance
  • Repeat creatinine every 24h
  • Early discussion with nephrologist and need for biopsy and initiation of i.v. (methyl)prednnisolone 2 mg/kg
  • Restart ICPI only when steroids are completely stopped and after multidisciplinary discussion

Assessment and Investigations

  • Consider renal biopsy
  • Perform UPCR


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