# ICI Kidney Injury: Recovery and Cancer Control

Establish laboratory surveillance, symptom reporting, and a shared response plan so recurrent injury is recognized promptly.

![Infographic: ICI Kidney Injury: Recovery and Cancer Control](https://urinenephrology.org/visual-reference/images/mastery-ici-treatment.png?v=20261003c)

## Two treatment priorities

Immune-mediated kidney injury must be addressed while considering the value of ongoing cancer therapy. Severity and diagnostic certainty shape the balance.

## Grade with clinical context

Baseline kidney function, trajectory, urine findings, other organ toxicity, and hemodynamic factors matter alongside a creatinine-based grade.

## Remove competing insults

Treat dehydration, infection, obstruction, and avoidable nephrotoxic exposure. Reconsider the diagnosis when the course is atypical.

## Assess the response before extending treatment

After the selected intervention, follow creatinine, proteinuria when relevant, symptoms, and steroid toxicity. Failure to improve should prompt review of the diagnosis, continued culprit exposure, obstruction, infection, and whether biopsy is now needed. Do not prolong immunosuppression solely because the original label was immune nephritis.

## Make rechallenge a shared decision

Discuss prior lesion and severity, degree of recovery, cancer response, alternative regimens, and ongoing immunosuppression. If restarting is chosen, document baseline kidney tests, a surveillance schedule, symptom reporting, and the response to recurrence. Rechallenge is neither automatically safe nor universally prohibited.

## Plan follow-up before restarting

Establish laboratory surveillance, symptom reporting, and a shared response plan so recurrent injury is recognized promptly.

## Source lessons

- [ici nephrotoxicity treatment md anderson review](https://urinenephrology.org/mastery/onconephrology/ici-nephrotoxicity-treatment-md-anderson-review.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.