This is a single-center retrospective cohort study conducted at Massachusetts General Hospital Cancer Center. Patients met the following criteria for ICI-induced nephritis if they had ≥50% increase in creatinine above their baseline creatinine at the initiation of ICI, their AKI was attributed to ICI by their treating provider, and they were treated initially with >0.5 mg/kg prednisone equivalent per day. Because we only wanted to include control patients who could have been eligible for our rapid corticosteroid taper protocol, we excluded anyone who was concurrently experiencing another life-threatening irAE (such as myocarditis, pneumonitis, hepatitis, or colitis) as the dosage of corticosteroids needed would be driven by the other irAE. We also excluded patients who had nephrotic range proteinuria, or an alternative pathological lesion found on kidney biopsy, and those receiving care in an intensive care unit or on hospice at the time of diagnosis of ICI-induced nephritis (figure 1).

Patientflow. Patients who met inclusion criteria were deemed to have been eligible for “rapid- taper corticosteroids.” The historical control group had been prescribed standard steroid taper by treating providers (following National Comprehensive Cancer Network guidelines). AIN, acute interstitial nephritis; GBM, glomerular basement membrane; ICI, immune checkpoint inhibitor; irAE, immune related adverse event; MGH, Massachusetts General Hospital; TMA, thrombotic microangiopathy; SOC, standard of care.

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