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Renal toxicities associated with pembrolizumab
Hassan Izzedine1,2, Alexis Mathian3, Stephane Champiat4
1Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France.
Clinical Kidney Journal
|February 13, 2019
Summary
Pembrolizumab can cause kidney damage, including acute tubular injury and acute interstitial nephritis. Corticosteroid treatment improves kidney function in these cases.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Pembrolizumab, an anti-programmed cell death 1 agent, is increasingly used in cancer treatment.
- Renal toxicities associated with pembrolizumab are not well-characterized due to infrequent kidney biopsies.
- Understanding these toxicities is crucial for patient management.
Purpose of the Study:
- To describe the clinic-biological and histopathological features of pembrolizumab-related nephropathy.
- To evaluate the treatment response in patients with kidney injury.
- To characterize the incidence and spectrum of renal toxicities.
Main Methods:
- A monocentric case series study was conducted.
- Included pembrolizumab-treated cancer patients with renal toxicity from 2015 to 2017.
- All patients underwent kidney biopsy.
Main Results:
- 12 patients (1.77% of 676) developed renal toxicity.
- Presentations included acute kidney injury and proteinuria.
- Biopsies revealed acute tubular injury (ATI), acute interstitial nephritis (AIN), and minimal change disease (MCD).
- Pembrolizumab withdrawal and corticosteroids were effective for recovery.
- One patient experienced recurrent AIN upon drug reintroduction.
Conclusions:
- ATI, AIN, and MCD are common kidney involvements with pembrolizumab.
- Kidney dysfunction can be severe but is often isolated.
- Corticosteroids are beneficial for AIN and improve glomerular filtration rate.
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