Acute kidney injury from immune checkpoint inhibitor use

Abstract

Immune checkpoint inhibitors are novel oncological medications, current classes of which include monoclonal antibodies that target inhibitory receptors cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), programmed death 1 protein (PD-1) and programmed death-ligand 1. While they are novel in their ability to treat cancer, they also have a unique spectrum of immune-related adverse events. Renal-related immune adverse events, though rare, are an increasingly recognised clinical entity. We present the case of a 67-year-old man with acute kidney injury (AKI) after the second cycle of combination anti-CTLA-4 and anti-PD-1 antibodies for metastatic cutaneous melanoma. He presented with vomiting and diarrhoea, and AKI secondary to dehydration was treated with aggressive rehydration. After failing to recover biochemically, a renal biopsy was performed, which demonstrated severe acute interstitial nephritis. The culprit medications were held and he was treated with steroids. With immunosuppression, creatinine improved to pretreatment values.

Clinicopathological Features of Kidney Injury Related to Immune Checkpoint Inhibitors: A Systematic Review

“…Twenty-four patients from 17 case reports [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ] and 3 case series [ 32 , 33 , 34 ] had information on the immunohistochemistry (IHC) staining of kidney infiltrating cells. All 24 patients presented with ATIN, with one case having concomitant glomerulonephritis (not specified).…”

Association of Acute Kidney Injury Receiving Kidney Replacement Therapy With Prognosis of Critically Ill Patients With and Without Cancer: A Retrospective Study

“…These include direct tubular injury (such as by Platinum-containing regimens), tubulointerstitial disease, and crystalline nephropathy, but also induction of glomerular injury and glomerular disease (focal segmental sclerosis) and thrombotic microangiopathy (16). Renal side effects can also be seen during recently introduced targeted therapies and immunotherapy-based anticancer treatment modalities such as immune checkpoint inhibitors (33, 34). Indirect effects may also be mediated by cytokine release, capillary leak syndrome, and hypovolemia.…”