Immune checkpoint inhibitors are increasingly used to treat a variety of solid-organ and hematologic cancers. However, overactivation of the immune system can lead to immune-related adverse events, which are increasingly recognized in the kidney. There have been only rare reported cases of checkpoint inhibitor–associated glomerulonephritis and renal vasculitis, although vasculitis in other organs has been well described. We report 4 cases of renal vasculitis or pauci-immune glomerulonephritis after checkpoint inhibitor therapy. Three patients had renal small- to medium-vessel vasculitis and 1 had focally crescentic pauci-immune glomerulonephritis. Three patients presented with acute kidney injury, and 1 presented with nephrotic syndrome and hematuria. Three patients were tested for antineutrophil cytoplasmic antibodies, which were negative. The time from checkpoint inhibitor initiation to immune-related adverse event presentation ranged from 2 weeks to 24 months. Three patients were treated with glucocorticoids, resulting in clinical resolution. Our series demonstrates that renal vasculitis and pauci-immune glomerulonephritis are important considerations in the differential diagnosis of checkpoint inhibitor–related reductions in kidney function.

免疫检查点抑制剂越来越多地用于治疗各种实体器官和血液系统癌症。但是，免疫系统过度激活会导致免疫相关的不良事件，这种不良事件在肾脏中越来越多地被认识到。尽管其他器官的血管炎已有很好的描述，但只有极少数报道了与检查点抑制剂相关的肾小球肾炎和肾血管炎的病例。我们报告了4例检查点抑制剂治疗后发生的肾血管炎或弱免疫性肾小球肾炎。3例患有肾小血管至中血管炎，1例患有局灶性新月体性小球免疫性肾小球肾炎。3例出现急性肾损伤，1例出现肾病综合征和血尿。对三名患者的抗中性粒细胞胞浆抗体进行了测试，结果均为阴性。从检查点抑制剂开始到出现免疫相关不良事件的时间为2周至24个月。3例患者接受了糖皮质激素治疗，从而获得了临床解决方案。我们的系列研究表明，在鉴别诊断与检查点抑制剂相关的肾功能下降中，肾血管炎和免疫球蛋白肾小球肾炎是重要的考虑因素。