Abstract
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.