Acute tubulointerstitial nephritis and IgM deposits on glomerular capillary walls after immunotherapy with nivolumab for metastatic renal cell carcinoma.

Abstract

Nivolumab is an anti-programmed cell death-1 antibody that is utilized as an immune checkpoint inhibitor for several malignancies. However, this agent is associated with immune-related adverse events (irAEs), mainly in the spectrum of autoimmune disease including interstitial pneumonia, colitis, type 1 diabetes, and renal impairment. We herein present the case of a 59-year-old man with renal cell carcinoma who developed worsening renal function approximately 4 months after initiation of nivolumab. Urinalysis showed proteinuria and microscopic hematuria along with increase levels of N-acetyl-β-D-glucosaminidase. Renal biopsy revealed acute tubulointerstitial nephritis and thickening of the glomerular basement membranes. Immunofluorescence showed granular IgM deposits in capillary loops. We initiated high-dose prednisolone therapy with nivolumab, which improved renal function and achieved complete remission of proteinuria. Although renal irAEs are considered to be rare and glomerulonephropathy is not typical presentation, physicians need the close monitoring of renal function and urinalysis in patients under immunotherapy with this agents. In addition, our case provides a possible link between nivolumab and immune-mediated glomerulonephropathy.

• Authors: Taisuke Irifuku, Ayaka Satoh, Hiroki Tani, Kouichi Mandai, Takao Masaki
• Journal: CEN case reports (CEN Case Rep) Vol. 9 Issue 1 Pg. 48-54 (02 2020) ISSN: 2192-4449 [Electronic] Japan
• PMID: 31605271 (Publication Type: Case Reports, Journal Article)

Chemical References

• Glucocorticoids
• Immune Checkpoint Inhibitors
• Immunoglobulin M
• Nivolumab
• Prednisolone

Topics

• Acute Kidney Injury (chemically induced, drug therapy)
• Biopsy
• Carcinoma, Renal Cell (drug therapy, immunology, secondary)
• Fluorescent Antibody Technique (methods)
• Glucocorticoids (administration & dosage, therapeutic use)
• Humans
• Immune Checkpoint Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Immunoglobulin M (immunology)
• Kidney (pathology)
• Kidney Glomerulus (blood supply, pathology)
• Kidney Neoplasms (pathology)
• Male
• Middle Aged
• Nephritis, Interstitial (chemically induced)
• Nivolumab (administration & dosage, adverse effects, therapeutic use)
• Prednisolone (administration & dosage, therapeutic use)
• Proteinuria (etiology)
• Treatment Outcome