ORIGINAL RESEARCH article
Front. Med.
Sec. Nephrology
Clinical characteristics, management, and prognostic outcomes of ipilimumab-induced nephritis
Provisionally accepted
- 1Xiangtan Central Hospital, Xiangtan, China
- 2People's Hospital of Ningxiang City, Changsha, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Ipilimumab-induced nephritis is a rare but potentially severe immune-related adverse event with incompletely defined clinical features and outcomes. This study aimed to synthesize its clinical presentation, pathology, management, and prognosis to facilitate timely recognition and evidence-based care. Methods: We identified cases of ipilimumab-induced nephritis from 28 published articles up to May 31, 2025, and abstracted individual patient-level data for descriptive analysis. Results: A total of 30 patients were included (26 male, 4 female; median age 63 years [range: 43, 78]). The median onset of nephritis following ipilimumab initiation was 7 weeks (range: 1, 48 weeks). Clinically, patients commonly presented with fatigue (26.7%), fever (20.0%), rash (13.3%), and weight loss (13.3%). Laboratory findings included elevated serum creatinine (median 3.4 mg/dL, range: 1.6, 10.4), eosinophilia (18.5%), proteinuria (14.8%), urinary tract infection (11.1%), increased C-reactive protein (7.4%), and neutrophilic leukocytosis (3.7%). Histopathological analysis revealed acute tubulointerstitial nephritis in 87.5% of cases, followed by IgA nephropathy (12.5%), and interstitial edema (4.2%). The cornerstone of treatment was immediate discontinuation of ipilimumab, coupled with systemic corticosteroids. In select cases, immunosuppressive agents (e.g., mycophenolate mofetil, infliximab, cyclophosphamide) or renal replacement therapies (hemodialysis, plasma exchange) were utilized, though their efficacy requires further validation. Clinical improvement was observed in 93.3% of patients, with a median recovery time of 7 weeks (range: 1, 36 weeks), while 3.3% experienced fatal outcomes. Conclusion: These findings underscore the importance of early recognition and prompt intervention. A thorough clinical evaluation, including symptom assessment, physical examination, and laboratory testing, is essential for accurate diagnosis. Corticosteroids remain the mainstay of therapy, and early drug withdrawal is critical in mitigating renal injury.
Keywords: ipilimumab, Nephritis, Acute Kidney Injury, Immune-related adverse events, Management
Received: 25 Nov 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Xiao, Xie, Liu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiang Liu
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.