Chimeric antigen receptor (CAR) T-细胞疗法是针对癌细胞的新型免疫治疗方法，已被证明可以在某些难治性血液恶性肿瘤中引起持久缓解。然而，CAR T-细胞疗法有不良影响，如细胞因子释放综合征（CRS），免疫效应相关神经毒性综合征（ICANS），肿瘤溶解综合征（TLS）和急性肾损伤（AKI）等。很少有研究探讨CAR T-细胞疗法对肾脏的影响。在本综述中，我们总结了有关CAR T-细胞疗法在存在肾功能不全/AKI和由CAR T-细胞疗法引起的AKI患者的安全性资料。CAR T-细胞后30％的患者发生AKI，其中包括CRS、血液噬细胞淋巴组织细胞增生症（HLH）、TLS、血清细胞因子和炎症生物标志物等多种病理生理机制参与。但是，CRS通常报告为潜在机制。总体而言，在我们包括的研究中，18％的患者接受CAR T-细胞疗法后出现AKI，大多数情况可以通过适当治疗得以逆转。虽然一期临床试验排除了存在显著肾毒性的患者，但Mamlouk等人和Hunter等人的两项研究报告了对难治性弥漫性大B细胞淋巴瘤透析依赖患者的成功治疗，并证明CAR T-细胞疗法和淋巴减毒（Flu/Cy）可以安全地使用。©2023年作者。

Chimeric antigen receptor (CAR) T-cell therapy is novel immunotherapy targeting specifically cancerous cells, and has been shown to induce durable remissions in some refractory hematological malignancies. However, CAR T-cell therapy has adverse effects, such as cytokine release syndrome (CRS), immune effector-associated neurotoxicity syndrome (ICANS), tumor lysis syndrome (TLS), and acute kidney injury (AKI), among others. Not many studies have covered the repercussions of CAR T-cell therapy on the kidneys. In this review, we summarized the available evidence on the safety profile of CAR T-cell therapy in patients with pre-existing renal insufficiency/AKI and in those who develop AKI as a result of CAR T-cell therapy. With a 30% incidence of AKI post-CAR T-cell, various pathophysiological mechanisms, such as CRS, hemophagocytic lymphohistiocytosis (HLH), TLS, serum cytokines, and inflammatory biomarkers, have been shown to play a role. However, CRS is commonly reported as an underlying mechanism. Overall, 18% of patients in our included studies developed AKI after receiving CAR T-cell therapy, and most cases were reversible with appropriate therapy. While phase-1 clinical trials exclude patients with significant renal toxicity, two studies (Mamlouk et al. and Hunter et al.) reported successful treatment of dialysis-dependent patients with refractory diffuse large B-cell lymphoma, and demonstrated that CAR T-cell therapy and lymphodepletion (Flu/Cy) can be safely administered.© 2023. The Author(s).