Immunotherapy-Induced Acute Tubulointerstitial Nephritis
Kevin Parza1, Kevin Dao1, Pooja Patel1
1Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA.
Cureus
|June 24, 2021
Summary
Immunotherapy for advanced melanoma can cause kidney damage, specifically acute tubulointerstitial nephritis (ATIN). Early recognition and treatment are crucial for patients receiving ipilimumab and nivolumab.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Immunotherapy, particularly ipilimumab and nivolumab, is a preferred treatment for advanced melanoma due to its favorable side-effect profile compared to chemotherapy.
- Common immunotherapy side effects involve the gastrointestinal, pulmonary, and dermatologic systems.
- Nephrotoxic side effects from immunotherapy are rare but serious.
Related Concept Videos
Acute Kidney Injury II: Pathophysiology
432
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
432
Acute Pyelonephritis I: Introduction
154
Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
154
Acute Pyelonephritis II: Diagnostic Studies and Management
95
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
95
Tumor Immunotherapy
790
Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
790
Acute Kidney Injury IV: Diagnostic Studies and Prevention
108
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
108
Kidney Transplant II: Surgical Procedure
108
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
108


