Renal dosing
Does the kidney come back?
A cross-drug read on nephrotoxicity outlook: whether an agent’s kidney injury usually recovers or leaves a chronic deficit, whether dialysis has been reported, and whether re-exposure is tolerated. Every cell is distilled from the agent’s own cited outcome literature — filter by recovery trajectory, dialysis signal, or a documented rechallenge disposition.
46 agents
| Agent | Recovery | Chronic signal | Rechallenge | Sources |
|---|---|---|---|---|
| Carmustine (BCNU)Nitrosourea alkylator | Often permanent | CKD / eGFR decline | — | PMID 7272960 (opens PubMed in a new tab) |
| IfosfamideOxazaphosphorine alkylator | Often permanent | CKD / eGFR declineDialysis / RRT | — | PMID 29606257 (opens PubMed in a new tab) |
| Lomustine (CCNU)Nitrosourea alkylator | Often permanent | CKD / eGFR decline | — | PMID 7272960 (opens PubMed in a new tab) |
| Lutetium-177 DotatateRadioligand therapy (PRRT) | Often permanent | CKD / eGFR decline | — | PMID 24196919 (opens PubMed in a new tab) |
| SemustineNitrosourea (alkylating) | Often permanent | CKD / eGFR decline | — | PMID 6360348 (opens PubMed in a new tab) |
| AtezolizumabAnti-PD-L1 antibody | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| AvelumabAnti-PD-L1 antibody | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| BortezomibProteasome inhibitor | Variable | — | — | PMID 34680184 (opens PubMed in a new tab) |
| CarfilzomibProteasome inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseTMA has recurred after a treatment break and re-escalation — reintroduce only with close monitoring. | PMID 38658194 (opens PubMed in a new tab) |
| CemiplimabAnti-PD-1 antibody | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| CisplatinPlatinum agent | Often partial recovery | CKD / eGFR declineDialysis / RRT | — | PMID 36229672 (opens PubMed in a new tab)PMID 38538012 (opens PubMed in a new tab) |
| CosibelimabPD-L1 immune checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| DostarlimabAnti-PD-1 antibody | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| DurvalumabAnti-PD-L1 antibody | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| GemcitabineNucleoside analog | Variable | CKD / eGFR declineDialysis / RRT | ContraindicatedOnce TMA is suspected the drug is stopped permanently; rechallenge risks recurrence and worse renal outcomes. | PMID 12324937 (opens PubMed in a new tab) |
| IpilimumabCTLA-4 checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| NivolumabPD-1 checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab) |
| PembrolizumabPD-1 checkpoint inhibitor | Often partial recovery | CKD / eGFR decline | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 34625513 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab)PMID 31896554 (opens PubMed in a new tab) |
| PemetrexedAntifolate | Often partial recovery | CKD / eGFR decline | — | PMID 41614227 (opens PubMed in a new tab) |
| PenpulimabPD-1 immune checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| RelatlimabImmune checkpoint inhibitor (anti-LAG-3) | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| RetifanlimabPD-1 immune checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| StreptozocinNitrosourea alkylator | Often partial recovery | CKD / eGFR decline | High recurrenceAbrupt AKI can recur on re-challenge. | PMID 11219485 (opens PubMed in a new tab) |
| SugemalimabPD-L1 immune checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| TislelizumabPD-1 immune checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| ToripalimabPD-1 immune checkpoint inhibitor | Often partial recovery | CKD / eGFR declineDialysis / RRT | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab)PMID 37499561 (opens PubMed in a new tab) |
| VenetoclaxBCL-2 inhibitor | Variable | — | — | PMID 38421404 (opens PubMed in a new tab) |
| Zoledronic acidBisphosphonate | Often partial recovery | CKD / eGFR declineDialysis / RRT | — | PMID 12787420 (opens PubMed in a new tab)PMID 39529985 (opens PubMed in a new tab) |
| AzacitidineHypomethylating agent | Usually reversible | — | — | PMID 11219485 (opens PubMed in a new tab) |
| BevacizumabAnti-VEGF antibody | Usually reversible | — | — | PMID 27154025 (opens PubMed in a new tab) |
| CarboplatinPlatinum agent | Usually reversible | — | — | PMID 35190107 (opens PubMed in a new tab) |
| CetuximabAnti-EGFR antibody | Usually reversible | — | — | PMID 17466895 (opens PubMed in a new tab) |
| CyclophosphamideOxazaphosphorine alkylator | Usually reversible | — | — | PMID 9415661 (opens PubMed in a new tab) |
| Methotrexate (high-dose)Antifolate | Usually reversible | — | Often toleratedHigh-dose methotrexate has been safely resumed after AKI and glucarpidase rescue in a pediatric series. | PMID 20679598 (opens PubMed in a new tab)PMID 22252903 (opens PubMed in a new tab) |
| MitotaneAdrenolytic | Usually reversible | — | — | PMID 35567656 (opens PubMed in a new tab) |
| Moxetumomab pasudotoxImmunotoxin (anti-CD22 PE38) | Usually reversible | — | — | PMID 30030507 (opens PubMed in a new tab) |
| OxaliplatinPlatinum agent | Usually reversible | Dialysis / RRT | ContraindicatedRe-exposure after a documented immune hemolytic or TMA event is avoided — reactions recur faster and more severely. | PMID 36978021 (opens PubMed in a new tab) |
| PanitumumabAnti-EGFR antibody | Usually reversible | — | — | PMID 17466895 (opens PubMed in a new tab) |
| RamucirumabAnti-VEGFR2 antibody | Usually reversible | — | — | PMID 31277139 (opens PubMed in a new tab) |
| SonrotoclaxBCL-2 inhibitor | Usually reversible | — | — | PMID 42385124 (opens PubMed in a new tab) |
| Ziv-afliberceptVEGF trap | Usually reversible | — | — | PMID 36309669 (opens PubMed in a new tab) |
| Immune Checkpoint InhibitorsImmune checkpoint inhibitor | — | — | Case-by-caseIn the multicenter ICI-AKI cohort ~22% were rechallenged and ~23% of those developed recurrent AKI — feasible but an individualized, co-managed decision. | PMID 31896554 (opens PubMed in a new tab) |
| Mitomycin CAntitumor antibiotic | Not reported | — | — | PMID 2497229 (opens PubMed in a new tab) |
| PamidronateBisphosphonate | Not reported | CKD / eGFR decline | — | PMID 11373339 (opens PubMed in a new tab) |
| ProcarbazineHydrazine alkylating agent | — | — | High recurrenceHypersensitivity-type injury has been described after re-exposure. | — |
| TagraxofuspIL-3 immunotoxin | — | — | Often toleratedRecurrence in later cycles is uncommon with proactive monitoring. | — |
Recovery class and rechallenge disposition summarize documented cohort/case experience, not an individual prognosis; “—” means the agent has no distilled entry for that column yet, not that the risk is absent. Of 291 catalog agents, 23 carry a documented rechallenge disposition; the rest have no distilled rechallenge entry in this atlas yet, which is not a statement of safety. Educational content — not medical advice. Confirm against the primary source and the treating team.