Renal biopsy in the era of immune-based combination therapies for metastatic renal cell carcinoma: Current practices and considerations

The rise of immune-based combination therapies has revolutionized the treatment landscape for metastatic renal cell carcinoma (mRCC), offering significant improvements in response rates and survival. However, along with these advancements come challenges in managing treatment-related adverse events, particularly renal toxicities. Kidney biopsies represent the gold standard in diagnosing and managing these complications, providing insights into histopathological patterns and guiding therapeutic strategies. It is important to emphasize that in most of the cases expertise in onco-nephrology can enable accurate diagnosis and management of nephrotoxicities, and that in clinical practice, renal biopsy is often not easily feasible. Research efforts are underway to identify biomarkers and imaging techniques that can accurately detect renal damage characteristics without the need for invasive procedures. Promising candidates have been identified; however, validation studies are essential to enhance their effectiveness and integrate them into standard clinical practice. This paper underscores the importance of individualized approaches in managing renal adverse events and calls for further research to improve diagnostic capabilities for acute kidney injury in the context of immune-based combination therapies.