Progressive chronic kidney function decline as a clinical presentation of immune checkpoint inhibitor-associated nephrotoxicity

Abstract

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. However, ICIs can be limited by inflammatory toxicities referred to as immune related-adverse events (irAEs). Clinical presentation of acute kidney injury (AKI) with corresponding pathological features of acute interstitial nephritis (AIN) is the most common manifestation of kidney irAE. Case discussion: A 74-year-old man with invasive squamous cell carcinoma (SCC) and chronic kidney disease (CKD) developed progressive kidney function decline after initiating treatment with cemiplimab (a programmed death protein 1 inhibitor). Because of the outstanding treatment response, and the fact that the patient had no other irAEs, cemiplimab was continued with close monitoring of kidney function. Over the course of 2 years, his creatinine increased from 2.1 to 3.1 mg/dL. Two years into treatment, he presented to the clinic with nausea, vomiting and diarrhea. He was hospitalized and underwent endoscopic examination that led to the diagnosis ICI-associated enterocolitis. After initiation of high dose glucocorticoids, his serum creatinine rapidly improved to his pre-ICI baseline. Conclusion: ICI-associated nephrotoxicity should be considered as a possible cause of rapidly progressive CKD; clinicians must keep a high suspicion for irAEs even in patients who have been receiving ICIs for over 1 year.