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IgA Nephropathy Secondary to Ipilimumab Use
Sean C Dougherty1, Nisa Desai1, Helen P Cathro2
1Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA.
Case Reports in Nephrology and Dialysis
|December 24, 2021
Summary
Checkpoint inhibitor ipilimumab can cause rare kidney damage. A patient with non-small-cell lung cancer developed IgA nephropathy, requiring dialysis despite treatment, highlighting the need for vigilant monitoring of immune-related adverse events.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Ipilimumab, a cytotoxic T-lymphocyte-associated protein 4 inhibitor, treats various cancers.
- Immune-related adverse events (irAEs) are common with checkpoint inhibitors (CPIs), but nephrotoxicity is less frequent.
- Early identification and management of CPI-induced irAEs are crucial for patient outcomes.
Observation:
- A 70-year-old female with stage IV non-small-cell lung cancer (NSCLC) presented with nephrotic-range proteinuria four weeks after ipilimumab therapy.
- Renal biopsy revealed IgA nephropathy, presumed secondary to ipilimumab treatment.
- The patient's acute kidney injury progressed despite corticosteroid treatment, necessitating hemodialysis.
Findings:
- This case highlights a rare instance of IgA nephropathy potentially induced by ipilimumab.
- The patient's condition worsened, leading to end-stage kidney disease and transition to hospice care.
- The temporal association between ipilimumab initiation and the onset of renal symptoms suggests a causal link.
Implications:
- This report underscores the importance of monitoring for uncommon irAEs, including nephrotoxicity, associated with CPI therapy.
- Clinicians should maintain a high index of suspicion for renal complications in patients receiving ipilimumab.
- Continued surveillance for irAEs throughout the treatment course is essential for managing patients on CPIs.
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