Abstract: SA-PO281
A Case of Lenalidomide-Induced Tubulointerstitial Nephritis
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Dinh, Alex, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Palmer, Matthew, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Hogan, Jonathan J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Introduction
Lenalidomide is a thalidomide-derivate immunomodulatory drug that has shown efficacy in multiple myeloma and relapsed Hodgkin Lymphoma (HL). Renal insufficiency with lenalinomide is commonly-observed but poorly characterized. We describe a patient with relapsed HL who developed AKI and lower extremity rash while taking lenalidomide, with kidney biopsy showing tubulointerstitial nephritis.
Case Description
A 24-year-old male had refractory HL previously treated with autologous stem cell transplant four years prior to presentation, and nivolumab, pembrolizumab, and chimeric antigen receptor T cell therapy two years prior to presentation. During this time his SCr increased from 0.5-0.8 mg/dL to 1.1-1.6 mg/dL. Lenalidomide was started and over four months his SCr elevated to 2.3 mg/dL. Urinalysis was negative for protein, blood and leukocyte esterase, and microscopy showed no red blood cells or white blood cells. Peripheral blood eosinophils were elevated with a peak of 14%. Imaging revealed no evidence of obstruction. Lenalidomide was discontinued without improvement of his SCr. During the same month of discontinuing lenalidomide, he developed a rash on his lower extremity, and skin biopsy showed psoriasiform epidermal hyperplasia and chronic inflammation. A kidney biopsy showed patchy tubulointerstitial inflammation accompanied by tubulitis with mild chronicity, and approximately 10% interstitial fibrosis consistent with a diagnosis of tubulointerstitial nephritis. Mononuclear infiltrative cells were negative for lymphoma. He received three days of intravenous methylprednisolone 125 mg and oral prednisone with a subsequent steroid taper. His SCr returned to his prior baseline of 1.1 to 1.6 mg/dL at one month follow-up and his lower extremity rash resolved. Peripheral blood eosinophils returned to normal.
Discussion
Renal insufficiency associated with lenalidomide is commonly reported in plasma cell dyscrasias, but very few patients undergo kidney biopsies to establish the mechanism of kidney injury. The patient’s treatment exposures prior to receiving lenalidomide included multiple T cell modulating therapies. Three case reports to date have been published describing lenalidominde-associated interstitial nephritis in patients with multiple myeloma. This is the first case to describe lenalidomide-induced interstitial nephritis in a patient undergoing treatment for HL.