Two Acute Kidney Injury Episodes After ICI Therapy: a Case Report

Overview

Journal CEN Case Rep

Specialty Nephrology

Date 2024 Mar 7

PMID 38453804

Authors

Kohei Ishiga

Ryu Kobayashi

Tomohiko Kanaoka

Jotaro Harada

Ikuma Kato

Satoshi Fujii

Hiromichi Wakui

Yoshiyuki Toya

Kouichi Tamura

Affiliations

Soon will be listed here.

Abstract

A 74-year-old Japanese male with lung squamous cell carcinoma received his first dose of immune checkpoint inhibitors (ICIs): ipilimumab and nivolumab. He developed acute kidney injury (AKI) and was admitted to our department. We diagnosed kidney immune-related adverse effects (irAE), and a kidney biopsy revealed acute tubulointerstitial nephritis. We started oral prednisolone (PSL) and his AKI immediately improved. The patient maintained stable findings after PSL was tapered off. However, seven months after the ICI administration, he developed rapid progressive glomerular nephritis and was admitted to our department again. The second kidney biopsy showed findings consistent with anti-glomerular basement membrane glomerulonephritis. Although the patient was treated with pulse methylprednisolone followed by oral PSL and plasma exchange, he became dependent on maintenance hemodialysis. To our knowledge, no case report has described two different types of biopsy-proven nephritis. In cases of suspected relapsing kidney irAEs, both a relapse of previous nephritis and the development of another type of nephritis should be considered.

References

Rao Ullur A, Cote G, Pelletier K, Kitchlu A . Immunotherapy in oncology and the kidneys: a clinical review of the evaluation and management of kidney immune-related adverse events. Clin Kidney J. 2023; 16(6):939-951. PMC: 10229281. DOI: 10.1093/ckj/sfad014. View

Kitchlu A, Jhaveri K, Wadhwani S, Deshpande P, Harel Z, Kishibe T . A Systematic Review of Immune Checkpoint Inhibitor-Associated Glomerular Disease. Kidney Int Rep. 2021; 6(1):66-77. PMC: 7783581. DOI: 10.1016/j.ekir.2020.10.002. View

Javaugue V, Watson M, Fervenza F, Nasr S . Atypical Antiglomerular Basement Membrane Nephritis Following Immune Checkpoint Inhibitor. Kidney Int Rep. 2022; 7(8):1913-1916. PMC: 9366294. DOI: 10.1016/j.ekir.2022.04.089. View

Takahashi N, Tsuji K, Tamiya H, Shinohara T, Kuroda N, Takeuchi E . Goodpasture's disease in a patient with advanced lung cancer treated with nivolumab: An autopsy case report. Lung Cancer. 2018; 122:22-24. DOI: 10.1016/j.lungcan.2018.05.015. View

Cortazar F, Kibbelaar Z, Glezerman I, Abudayyeh A, Mamlouk O, Motwani S . Clinical Features and Outcomes of Immune Checkpoint Inhibitor-Associated AKI: A Multicenter Study. J Am Soc Nephrol. 2020; 31(2):435-446. PMC: 7003302. DOI: 10.1681/ASN.2019070676. View

Fogazzi G, Ferrari B, Garigali G, Simonini P, Consonni D . Urinary sediment findings in acute interstitial nephritis. Am J Kidney Dis. 2012; 60(2):330-2. DOI: 10.1053/j.ajkd.2012.05.002. View

Muriithi A, Leung N, Valeri A, Cornell L, Sethi S, Fidler M . Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis. 2014; 64(4):558-66. DOI: 10.1053/j.ajkd.2014.04.027. View

Kyriazis P, Tiwary A, Freeman J, Landry D, Braden G . Atypical anti-glomerular basement membrane glomerulonephritis in a patient with metastatic melanoma treated with mitogen-activated protein kinase and immune checkpoint inhibitors: a case report. J Med Case Rep. 2021; 15(1):186. PMC: 8019162. DOI: 10.1186/s13256-021-02766-w. View

Cortazar F, Marrone K, Troxell M, Ralto K, Hoenig M, Brahmer J . Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors. Kidney Int. 2016; 90(3):638-47. PMC: 4983464. DOI: 10.1016/j.kint.2016.04.008. View

10.

Reynolds J, Sando G, Marsh O, Salama A, Evans D, Cook H . Stimulation of the PD-1/PDL-1 T-cell co-inhibitory pathway is effective in treatment of experimental autoimmune glomerulonephritis. Nephrol Dial Transplant. 2011; 27(4):1343-50. DOI: 10.1093/ndt/gfr529. View

11.

Brahmer J, Abu-Sbeih H, Ascierto P, Brufsky J, Cappelli L, Cortazar F . Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. 2021; 9(6). PMC: 8237720. DOI: 10.1136/jitc-2021-002435. View

12.

Tani T, Sugino K, Hashimoto K, Mii A, Kashiwagi T, Shimizu A . Concomitant Anti-GBM Glomerulonephritis and Acute Interstitial Nephritis Following Programmed Death Receptor-1 Blockade With Nivolumab. Kidney Int Rep. 2022; 7(10):2317-2318. PMC: 9546764. DOI: 10.1016/j.ekir.2022.08.020. View

13.

Gupta S, Short S, Sise M, Prosek J, Madhavan S, Soler M . Acute kidney injury in patients treated with immune checkpoint inhibitors. J Immunother Cancer. 2021; 9(10). PMC: 8496384. DOI: 10.1136/jitc-2021-003467. View

14.

Wanchoo R, Karam S, Uppal N, Barta V, Deray G, Devoe C . Adverse Renal Effects of Immune Checkpoint Inhibitors: A Narrative Review. Am J Nephrol. 2017; 45(2):160-169. DOI: 10.1159/000455014. View

15.

Reynolds J, Tam F, Chandraker A, Smith J, Karkar A, Cross J . CD28-B7 blockade prevents the development of experimental autoimmune glomerulonephritis. J Clin Invest. 2000; 105(5):643-51. PMC: 289170. DOI: 10.1172/JCI6710. View

16.

Couey M, Bell R, Patel A, Romba M, Crittenden M, Curti B . Delayed immune-related events (DIRE) after discontinuation of immunotherapy: diagnostic hazard of autoimmunity at a distance. J Immunother Cancer. 2019; 7(1):165. PMC: 6609357. DOI: 10.1186/s40425-019-0645-6. View

17.

Kitching A, Huang X, Tipping P, Holdsworth S . Effects of CTLA4-Fc on glomerular injury in humorally-mediated glomerulonephritis in BALB/c mice. Clin Exp Immunol. 2002; 128(3):429-35. PMC: 1906271. DOI: 10.1046/j.1365-2249.2002.01859.x. View

18.

Hultin S, Nahar K, Menzies A, Long G, Fernando S, Atkinson V . Histological diagnosis of immune checkpoint inhibitor induced acute renal injury in patients with metastatic melanoma: a retrospective case series report. BMC Nephrol. 2020; 21(1):391. PMC: 7487459. DOI: 10.1186/s12882-020-02044-9. View

19.

El Yamani N, Cote G, Riopel J, Marcoux N, Mac-Way F, Philibert D . Pembrolizumab-Induced Anti-GBM Glomerulonephritis: A Case Report. Kidney Med. 2023; 5(8):100682. PMC: 10320380. DOI: 10.1016/j.xkme.2023.100682. View

20.

Hoshina A, Endo S . Anti-glomerular basement membrane glomerulonephritis concurrent with membranous nephropathy and acute tubular interstitial nephritis in a lung cancer patient treated with pembrolizumab. CEN Case Rep. 2022; 12(2):230-236. PMC: 10151296. DOI: 10.1007/s13730-022-00750-x. View