Clinical Mastery Series
Author: Andrew Bland, MD, MBA, MS
Comprehensive clinical reviews at the intersection of oncology and nephrology. These evidence-based resources cover immune checkpoint inhibitor nephrotoxicity, glomerular disease in cancer patients, and hematologic emergencies with renal involvement.
The definitive review covering the full spectrum of immune checkpoint inhibitor kidney injury. Includes checkpoint pathway biology (CTLA-4, PD-1/PD-L1), mechanisms of renal immune tolerance loss, epidemiology and risk factors, clinical presentation, urinary findings, kidney biopsy interpretation, the complete ICI-associated glomerular disease spectrum (MCD, lupus-like nephritis, pauci-immune crescentic GN, membranous, C3-GN, IgA), grade-based management algorithms (CTCAE v5.0 with KDIGO integration), steroid-refractory disease escalation protocols, ICI rechallenge strategies, and special populations including transplant recipients and advanced CKD.
Key references: Cortazar 2020 (JASN), Herrmann & Perazella 2025 (Kidney Int), Kitchlu 2021 (KI Reports), ASCO 2021 Guidelines
A focused review on the diagnostic approach and pathologic characterization of ICI-associated acute kidney injury. Detailed coverage of ICI-ATIN pathophysiology (direct autoimmune vs. drug-amplified pathways), the urinary signature (sterile pyuria, WBC casts, subnephrotic proteinuria, FENa), differential diagnosis in cancer patients (prerenal, ATN, obstruction, pyelonephritis, GN), the ICI-ATIN diagnostic triad, comprehensive biopsy interpretation (light microscopy with histologic severity grading, immunofluorescence, electron microscopy), the PPI confounder, and emerging biomarkers (KIM-1, IL-6, cystatin C).
Key references: Cortazar 2020 (JASN), Cortazar 2016 (Kidney Int), Herrmann & Perazella 2025, Kitchlu 2021
Comprehensive review of this life-threatening hyperinflammatory syndrome. Covers primary (familial) vs. secondary HLH classification and triggers (infectious, malignancy-associated, autoimmune/MAS, iatrogenic including ICI and CAR-T), the IFN-γ–driven cytokine storm pathophysiology, clinical presentation and diagnostic mimics, HLH-2004 criteria and HScore with interpretation thresholds, systematic diagnostic workup (confirmatory plus trigger evaluation), treatment protocols (HLH-94/2004, emapalumab, ruxolitinib, anakinra), allogeneic HSCT as curative therapy, renal complications (hemodynamic AKI, macrophage infiltration, TMA, hemoglobinuria-mediated tubular injury), and special populations (neonatal, adult secondary, CAR-T IEC-HS, checkpoint inhibitor-associated).
Key references: HLH-2004 Guidelines (Henter 2007), HScore (Fardet 2014), HLH-2004 Study (Bergsten 2017), Emapalumab (Jordan 2020)
Paraprotein-related kidney disease and monoclonal protein screening are core onconephrology competencies. These reviews from the Amyloid Series and Paraprotein modules provide the essential diagnostic frameworks.
FLC reference ranges by eGFR (iStopMM), MASS-FIX panel, SPEP/immunofixation/FLC decision framework, kappa vs lambda patterns, Mayo MGUS risk stratification, and SLiM criteria. Essential for evaluating proteinuria in cancer patients and detecting paraprotein-related kidney disease.
ATTR cardiac amyloidosis, misleading echo findings, RHC hemodynamics in amyloid, and cardiac-predominant AL without nephrotic proteinuria. A dedicated learning pathway integrating cardiac, renal, and hematologic perspectives.
AL amyloidosis & multiple myeloma comprehensive review, cardiac amyloidosis diagnostic challenges case report, and AL amyloidosis inpatient case with kappa-dominant LCDD differential.
Andrew Bland, MD, MBA, MS | Clinical Mastery Series | Urine Nephrology Now
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