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Nivolumab-associated acute glomerulonephritis: a case report and literature review

Kyungsuk Jung1, Xu Zeng2, Marijo Bilusic3

  • 1Department of Medicine, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA. Kyungsuk.Jung@fccc.edu.

BMC Nephrology
|November 24, 2016
PubMed
Abstract

Insights

Nivolumab can cause kidney injury, including glomerulonephritis. Prompt steroid treatment and hemodialysis can restore kidney function without impacting cancer treatment effectiveness.

Area of Science:

  • Oncology
  • Nephrology
  • Immunology

Background:

  • Immune checkpoint inhibitors like nivolumab offer improved cancer treatment outcomes for various malignancies.
  • Nivolumab, an anti-programmed death 1 antibody, is approved for melanoma, lung, and kidney cancers.
  • These therapies can induce autoimmune side effects affecting multiple organ systems, including the kidneys.

Observation:

  • A 70-year-old male with kidney cancer experienced acute kidney injury while receiving nivolumab.
  • Kidney biopsy confirmed diffuse tubular injury and immune complex-mediated glomerulonephritis with subepithelial deposits.
  • The patient required nivolumab discontinuation, high-dose steroids, and hemodialysis.

Findings:

  • Immune-related adverse events in the kidney manifest as autoimmune glomerulonephritis and tubulointerstitial injury.
  • Treatment with systemic corticosteroids is generally effective for immune-related nephritis.
  • This case highlights the potential need for prolonged high-dose steroids and hemodialysis for recovery.

Implications:

  • Early recognition and management of nivolumab-induced kidney injury are crucial.
  • Aggressive immunosuppressive therapy may be necessary for renal recovery.
  • Maintaining immunosuppression for kidney injury did not appear to compromise nivolumab's anticancer efficacy in this case.
Keywords:
Acute kidney injuryAutoimmune nephritisCase reportImmunotherapyNivolumabRenal cell carcinoma

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