What are your next steps for managing biopsy-proven interstitial nephritis from checkpoint inhibitors in patients who do not have a response to prednisone?

As indicated by Dr. @Dr. First Last, based on their publication, if there is biopsy-proven evidence for AIN with no evidence of concurrent GN or vasculitis, then a trial of infliximab is reasonable. Our experience at our institution is that the creatinine increases if the prednisone is tapered too q...

If the biopsy was confirmed acute interstitial nephritis with no indication of glomerulonephritis or vasculitis would then increase steroids to 1mg/kg and add infliximab 5mg/kg for one dose and taper steroids off over 2 weeks.

Evaluation and Management of Suspected Immune-Mediated Nephritis

If there is certainty about the diagnosis of AIN, my next step would be to take another look at the biopsy. Patients with significant interstitial fibrosis on initial biopsy may have not have much GFR to salvage with prednisone and a limited response would not be surprising. I'd also make sure that ...