Immune checkpoint inhibitor–associated renal amyloid A amyloidosis: A case series and review of the literature

Lapman, Sebastian; Whittier, William L.; Parikh, Rushang; Khanin, Yuriy; Bijol, Vanesa; Wanchoo, Rimda; Jhaveri, Kenar D.

doi:10.1177/2399369320907598

Cited by 13 publications

(6 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lapman et al . [ 66 ] reported a series of three cases, of which two presented with severe kidney injury necessitating dialysis. Two of these patients were treated with corticosteroid and colchicine with limited or no improvement.…”

Section: Management Of Kidney Immune-related Adverse Eventsmentioning

confidence: 99%

Immunotherapy in oncology and the kidneys: a clinical review of the evaluation and management of kidney immune-related adverse events

Ullur

Côté

Pelletier

et al. 2023

Clinical Kidney Journal

View full text Add to dashboard Cite

Immune checkpoint inhibitors (ICI) are now widely used in the treatment of many cancers, and currently represent the standard of care for multiple malignancies. These agents enhance the T cell immune response to target cancer tissues, and have demonstrated considerable benefits for cancer outcomes. However, despite these improved outcomes, there are important kidney immune-related adverse events (iRAEs) associated with ICI. Acute tubulo-interstitial nephritis, remains the most frequent kidney iRAE, however glomerular lesions and electrolytes disturbances are increasingly being recognized and reported. In this review, we summarize clinical features and identified risk factors for kidney iRAEs, and discuss current understanding of pathophysiologic mechanisms. We highlight the evidence basis for guideline-recommended management of ICI-related kidney injury as well as gaps in current knowledge. We advocate for judicious use of kidney biopsy to identify ICI-associated kidney injury, and early use of corticosteroid treatment where appropriate. Selected patients may also be candidates for re-challenge with ICI therapy after a kidney iRAE, in view of current data on recurrent rates of kidney injury. Risk of benefits of re-challenge must be considered on an individual considering patient preferences and prognosis. Lastly, we review current knowledge of ICI use in the setting of patients with end-stage kidney disease (ESKD), including kidney transplant recipients and those receiving dialysis, which suggest that these patients should not be summarily excluded from the potential benefits of these cancer therapies.

show abstract

Section: Management Of Kidney Immune-related Adverse Eventsmentioning

confidence: 99%

Immunotherapy in oncology and the kidneys: a clinical review of the evaluation and management of kidney immune-related adverse events

Ullur

Côté

Pelletier

et al. 2023

Clinical Kidney Journal

View full text Add to dashboard Cite

show abstract

“…He had a particularly good treatment response for almost a year. However, he later developed secondary renal AA amyloidosis and tubulointerstitial nephritis, which is a very rare side effect of Atezolizumab, and only a few case reports/case series have documented this side effect [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Tubulointerstitial Nephritis and Secondary Renal Amyloidosis: A Rare Complication of Atezolizumab

Ullah,

Bin Naeem,

Jhatial

et al. 2023

Cureus

View full text Add to dashboard Cite

Lung cancer is the second most common malignancy in both genders and the most common cause of cancer-related deaths worldwide. Broadly, lung cancer is divided into two types: small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Non-small cell lung cancer accounts for 85% of the diagnoses of lung cancer. It is necessary to check for any targetable mutations, which can help in deciding the treatment plan for the patients. The patient we are reporting is a 70-year-old male with multiple co-morbidities diagnosed with non-small cell carcinoma, favoring adenocarcinoma on histopathology. He was started on Atezolizumab/Bevacizumab/Carboplatin/Paclitaxel (ABCP). He was switched to maintenance Atezolizumab/Bevacizumab after four cycles due to poor tolerance to carboplatin and paclitaxel. The patient presented with neutropenic colitis and acute kidney injury (AKI), requiring admission. workup revealed nephrotic range proteinuria with a high urinary albumin-to-creatinine ratio. He underwent a renal biopsy to ascertain the cause of his proteinuria, which showed marked acute and chronic tubulo-interstitial nephritis (TIN), amyloidosis, and global glomerulosclerosis. Secondary (AA) amyloidosis is characterized by the extracellular deposition of misfolded proteins. Although interstitial nephritis is a reported side effect of immune checkpoint inhibitors, AA amyloidosis is a rarer side effect. So, to determine the exact cause and early therapeutic intervention in immune checkpoint inhibitor-related kidney injury, large retrospective or prospective studies should be done.

show abstract

“…Finally, the patient with secondary amyloidosis, developed in the setting of pembrolizumab-induced rheumatoid arthritis, represents the first case of AA amyloidosis where the initial autoimmune inflammatory trigger for amyloid deposition has been identified. A few more case reports, describing AA amyloidosis upon immunotherapy administration, failed to associate it with a specific inflammatory/autoimmune background [ 17 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitors’ Associated Renal Toxicity: A Series of 12 Cases

Palamaris

Alexandris²,

Stylianou

et al. 2022

JCM

View full text Add to dashboard Cite

We present a series of twelve patients, bearing a wide range of solid malignancies, who received either PD-L1 or a combination of PD-L1 and CTLA-4 inhibitors. Following immunotherapy administration, they exhibited the clinical signs indicative of renal toxicity, including increased serum creatinine levels, proteinuria, nephrotic syndrome and/or hematuria. All patients underwent renal biopsy. Results: All cases demonstrated some degree of interstitial inflammation and tubular injury, while in five patients, glomerular alterations consistent with a specific glomerulopathy were also observed: secondary “lupus-like” membranous glomerulopathy in two cases and membranoproliferative glomerulonephritis, IgA glomerulonephritis and secondary AA amyloidosis in each of the remaining three patients. The two patients with “lupus-like” nephritis and the one with amyloidosis experienced nephrotic syndrome, while their creatinine was within normal range. In the remaining nine cases, deterioration of renal function was the main manifestation. Conclusion: Our findings harmonize with bibliographical data that identify tubulointerstitial nephritis as the most frequent histological lesion related to ICIs administration. The preferential involvement of tubulointerstitial tissue could be associated with the reported higher expression levels of PD-L1 on tubular epithelial cells, compared to glomeruli. On the other hand, glomerular involvement is probably a consequence of a systemic immune system reconstruction, induced by immune-checkpoints inhibition.

show abstract

Immune checkpoint inhibitor–associated renal amyloid A amyloidosis: A case series and review of the literature

Cited by 13 publications

References 16 publications

Immunotherapy in oncology and the kidneys: a clinical review of the evaluation and management of kidney immune-related adverse events

Immunotherapy in oncology and the kidneys: a clinical review of the evaluation and management of kidney immune-related adverse events

Acute Tubulointerstitial Nephritis and Secondary Renal Amyloidosis: A Rare Complication of Atezolizumab

Immune Checkpoint Inhibitors’ Associated Renal Toxicity: A Series of 12 Cases

Contact Info

Product

Resources

About