What are your management strategies for acute kidney injury attributed to pembrolizumab in patients with a kidney biopsy showing predominately acute tubular injury?

Acute interstitial nephritis is the more common type of kidney injury associated with immune checkpoint inhibitors. However, there is also associated acute tubular necrosis secondary to cytokine release from activated T cells. ATN can be also due to chemotherapy used in conjunction with ICI such as ...

If ATN is indeed the predominant lesion, then I’d work up for usual causes (meds, infection, hemodynamic shifts, etc.). I would not advise holding pembrolizumab in this case unless there are other indications to do so.