Immune checkpoint inhibitor-induced nephrotic syndrome: a pharmacovigilance analysis of 404 FAERS cases and literature case series

Immune checkpoint inhibitor (ICI)-related nephrotic syndrome is a rare but increasingly reported adverse event, where early-onset severe cases warrant heightened vigilance. This pharmacovigilance study assessed this correlation by analyzing the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) database from Q1 2011 to Q1 2025. A total of 404 cases of ICI-related nephrotic syndrome were identified in the FAERS database, with 84.1% of cases related to programmed cell death protein 1 (58.9%) or programmed death-ligand 1 (25.2%) inhibitors. Disproportionality signals were observed for six ICI monotherapies and one combination therapy: atezolizumab (ROR 6.84; 95% CI: 5.58–8.40), avelumab (ROR 5.54; 95% CI: 2.64–11.63), nivolumab (ROR 4.37; 95% CI: 3.64–5.25), pembrolizumab (ROR 3.44; 95% CI: 2.88–4.10), durvalumab (ROR 2.03; 95% CI: 1.12–3.66), ipilimumab (ROR 2.05; 95% CI: 1.07–3.94), and the combination therapy of nivolumab and ipilimumab (ROR 4.56; 95% CI: 3.56–5.83). Firth multivariate logistic regression analysis identified several independent risk factors, including advanced age (>65 years), malignant renal neoplasm, malignant mesothelioma, and the concomitant use of bevacizumab or lenvatinib. The median onset time was significantly shorter for severe cases than for non-severe cases (22.5 vs. 96.5 days, respectively; p = 0.0479). Additionally, a literature review of 18 cases provided supplementary information on the clinical features. This study provides vital pharmacovigilance insights regarding nephrotic syndrome related to ICIs, enhancing the understanding of its clinical implications.