Ipilimumab- and Nivolumab-Induced Colitis Causing Severe Hypokalemia and QTc Prolongation

Anson, David M.; Norton, Joseph; Chaucer, Benjamin; Bansal, Saurabh

doi:10.1155/2019/7896749

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…[ 90 ] found that hypokalemia (19%) and hypercalcemia (10%) were the most common reported electrolyte abnormalities after hyponatremia. Hypokalemia can result from gastrointestinal losses secondary to immune-mediated colitis [ 91 , 92 ] or kidney losses due to renal tubular dysfunction [ 93 , 94 ]. Both distal and proximal renal tubular acidosis (RTA) have been described in various case reports, and most cases had concomitant AKI [ 94–97 ].…”

Section: Electrolyte and Metabolic Disturbances Associated With Icimentioning

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

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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.

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Section: Electrolyte and Metabolic Disturbances Associated With Icimentioning

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

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“…Several reported cases illustrate the potential for severe hypokalemia related to immunotherapy resulting from gastrointestinal or kidney losses. Immune-mediated gastritis and colitis have been described with associated hypokalemia (41,42). Hypokalemia from kidney losses can also be induced by ICIs (43)(44)(45)(46).…”

Section: Hypokalemiamentioning

confidence: 99%

Electrolyte and Acid-Base Disorders Associated with Cancer Immunotherapy

Uppal

Workeneh

Rondon‐Berrios

et al. 2022

CJASN

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Novel immunotherapy drugs have changed the landscape of cancer medicine. Immune checkpoint inhibitors and chimeric antigen receptor T cells are being used and investigated in almost all solid cancers. Immune-related adverse events have been associated with immunotherapies. Acute kidney injury has been the most commonly associated kidney adverse event. In this review, we showcase the several associated electrolyte disorders seen with immunotherapy. Immune checkpoint inhibitors can lead to hyponatremia by several mechanisms, with the syndrome of inappropriate antidiuresis being the most common. Endocrine causes of hyponatremia are rare. Hypokalemia is not uncommon and is associated with both proximal and distal renal tubular acidosis. Hypercalcemia associated with immune checkpoint inhibitors has led to some interesting observations including immune checkpoint inhibitor-induced parathyroid hormone - related peptide production, sarcoid-like granulomas, and hyper-progression of the disease. Hypocalcemia and hyperphosphatemia may be seen with immune checkpoint inhibitor-induced tumor lysis syndrome. Chimeric antigen receptor T cell therapy-associated electrolyte disorders are also common. This is associated chiefly with hyponatremia, although other electrolyte abnormalities can occur. Early recognition and prompt diagnosis may help providers manage the mechanistically varied and novel electrolyte disorders associated with immunotherapy.

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Ipilimumab/nivolumab

2020

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Ipilimumab- and Nivolumab-Induced Colitis Causing Severe Hypokalemia and QTc Prolongation

Cited by 5 publications

References 6 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

Electrolyte and Acid-Base Disorders Associated with Cancer Immunotherapy

Ipilimumab/nivolumab

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