Rapidly Progressive Acute Kidney Injury Associated with Nivolumab Treatment

Okawa, Sachi; Shimonishi, Atsushi; Matsuura, Hiroaki; Ozeki, Taichi; Nishimura, J; Kayatani, Hiroe; Minami, Daisuke; Shinno, Yuki; Sato, Ken; Ota, Kosuke; Shibayama, Takuo

doi:10.1159/000505235

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…Diagnosing ICPi-associated AKI (ICPi-AKI) can be challenging as patients with advanced malignancies may have various other reasons for developing AKI, including fluid depletion, infection, exposure to nephrotoxic agents, cardiac failure, hypercalcemia, or urinary tract obstruction due to tumor progression [13]. The majority of kidney biopsies in patients with suspected ICPi-AKI show acute tubulointerstitial nephritis as the dominant histopathological lesion, although glomerular diseases are also reported [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study

et al. 2021

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Background Immune checkpoint inhibitors, approved for the treatment of various types of cancer, are known to cause a unique spectrum of side effects, including acute kidney injury (AKI). The aim of this study was to describe the incidence, risk factors, renal outcomes, and mortality of AKI in patients receiving checkpoint inhibitors. Methods Patients receiving checkpoint inhibitors between January 2013 and May 2020 at the University Medical Center Utrecht, the Netherlands, were identified using the Utrecht Patient Oriented Database. AKI was defined as an increase in serum creatinine of ≥1.5 times the baseline value, based on the Kidney Disease: Improving Global Outcomes criteria. Cox proportional hazard regression analysis was used to assess risk factors for AKI and to evaluate the relationship between AKI and mortality. Persistent renal dysfunction was diagnosed in AKI patients with a final serum creatinine measurement of >1.3 times the baseline value. Results Among 676 patients receiving checkpoint inhibitors, the overall incidence of AKI was 14.2%. Baseline variables independently associated with AKI were a gynecologic malignancy, monotherapy with ipilimumab, and the use of a diuretic, angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, or proton pump inhibitor at baseline. AKI was checkpoint inhibitor-associated in one third of all patients with AKI. Checkpoint inhibitor-associated AKI was mostly low-grade, occurred a median of 15 weeks after checkpoint inhibitor initiation, and resulted in persistent renal dysfunction in approximately 40% of the patients. Patients with all-cause AKI had a twofold increased mortality risk, but checkpoint inhibitor-associated AKI was not associated with increased mortality. Conclusions In this study, patients receiving checkpoint inhibitors frequently developed AKI due to various etiologies. AKI directly related to the effect of checkpoint inhibitor toxicity did not increase mortality. However, AKI not related to the effect of checkpoint inhibitor toxicity was associated with increased mortality.

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Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study

et al. 2021

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“…AKI developed after a variable time course from CPI exposure, ranging from some weeks to several months. A recent report, however, showed AKI occurring within a few days of the first administration of nivolumab [ 65 ]. The majority of the patients had sub-nephrotic proteinuria and pyuria, whereas fever, rash, and eosinophilia were absent in most.…”

Section: Discussionmentioning

confidence: 99%

Nephrotoxicity Associated with Novel Anticancer Agents (Aflibercept, Dasatinib, Nivolumab): Case Series and Nephrological Considerations

Piscitani

Sirolli

Liberato

et al. 2020

IJMS

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Cancer patients have an incidence of about 60% kidney disease development and are at elevated risk of acute renal damage. Kidney disease in these patients is frequently associated with nephrotoxicity from the ongoing oncological treatment. New anticancer therapeutic strategies, such as targeted therapies and immunotherapies, offer substantial benefits in the treatment of many neoplasms. However, their use is associated with significant nephrotoxicity, which qualitatively differs from that seen with traditional cytotoxic chemotherapy, while the underlying mechanisms are complex and still to be clearly defined. Nephrologists need to be knowledgeable about the array of such renal toxicities for effective collaboration with the oncologist in the prevention and management of kidney involvement. Renal adverse effects may range from asymptomatic proteinuria to renal failure, and their prompt identification and timely treatment is essential for optimal and safe care of the patient. In this article, after presenting clinical cases we discuss the differing renal toxicity of three novel anticancer agents (aflibercept, dasatinib, and nivolumab) and possible measures to counter it.

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“…Период времени с момента начала терапии ингибиторами ИКТ до развития иоНЯ со стороны почек широко варьирует. Описано развитие ОПП после введения первой дозы препарата [33,34], но в большинстве случаев поражение почек развивается через несколько недель или месяцев после начала терапии [24,25,28,29,32,35]. R. Wanchoo и соавт.…”

Section: передовая статьяunclassified

“…Морфологические изменения, выявляемые у пациентов с иммуноопосредованным поражением почек, затрагивают все почечные структуры (клубочки, интерстиций, канальцы, сосуды); табл. 2 [21,24,29,34,35,39,. Однако наиболее частым вариантом поражения почек на фоне терапии ингибиторами ИКТ является острый интерстициальный/ тубулоинтерстициальный нефрит (ОТИН).…”

Section: передовая статьяunclassified

“…Ниволумаб ОТИН [21,24,34,[48][49][50][51][52][53][54][55][56][57] Гранулематозный ОТИН [35,58] Острое повреждение канальцев [56] Иммуноглобулин A-нефропатия [59,60] Иммуноглобулин A-нефропатия с полулуниями + острое повреждение канальцев [61] Малоиммунный ГН/локально-почечный васкулит [29] Малоиммунный ГН+ОТИН [24] Локально-почечный васкулит [62] Локально-почечный васкулит + ОТИН [62] Локально-почечный васкулит + гранулематозный ОТИН [62] Мембранозная нефропатия + ОТИН [24] ФСГС [24,63] Пембролизумаб ОТИН [21,24,35,48,49,56,[64][65][66] Острое повреждение канальцев [56,64] Иммуноглобулин A-нефропатия + ОТИН [24,67] Малоиммунный ГН/локально-почечный васкулит [62] С3-нефропатия + гранулематозный ОТИН [24] БМИ [33,64,70] БМИ + острое повреждение канальцев …”

Section: передовая статьяunclassified

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Kidney injury associated with antitumor therapy: focus on the adverse events of modern immuno-oncological drugs

Bobkova

Sekacheva

2021

Terapevticheskii arkhiv

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Immune checkpoint inhibitors (ICIs), including cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and programmed death protein 1 (PD-1) or its ligand (PD-L1), are a new generation of immuno-oncological drugs that to date have demonstrated efficacy in a number of malignancies. The mechanism of ICT inhibitors action consist in the potentiation of the immune response by eliminating the tumor cells inhibitory effect on the T-lymphocytes activation. However, excessive immune system activation can cause the development of a special class of immune-related adverse events (irAEs) involved a wide variety of organs and systems, including the kidneys. Despite the fact that immuno-mediated kidney injury caused by ICI therapy develops quite rarely, it can be serious and determine the patient's prognosis, which necessitates early diagnosis and timely start of treatment. In this regard, awareness of the manifestations of ICI-associated renal irAEs is particularly relevant not only for oncologists and for nephrologists, but for doctors of other specialties. In this review, we elucidated the main variants of immuno-mediated kidney injury caused by ICI therapy, discussed possible predictors and mechanisms of their development, and considers the general principles of diagnosis and management of patients according to the severity of irAEs.

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Rapidly Progressive Acute Kidney Injury Associated with Nivolumab Treatment

Cited by 9 publications

References 16 publications

Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study

Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study

Nephrotoxicity Associated with Novel Anticancer Agents (Aflibercept, Dasatinib, Nivolumab): Case Series and Nephrological Considerations

Kidney injury associated with antitumor therapy: focus on the adverse events of modern immuno-oncological drugs

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