Abstract: SA-PO278
Membranoproliferative Glomerulonephritis (MPGN) Associated with Nivolumab Therapy
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
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Cruz Whitley, Jessica, University of California Davis Medical Center, Sacramento, California, United States
- Wani, Priyanka, University of California Davis Medical Center, Sacramento, California, United States
- Young, Brian Y., University of California Davis Medical Center, Sacramento, California, United States
Introduction
Nivolumab is a chemotherapeutic checkpoint inhibitor targeting PD-1 receptors on T cells. Nivolumab has classically been associated with acute interstitial nephritis (AIN). We present a case of Nivolumab associated nephrotic syndrome due to MPGN.
Case Description
75-year-old female with a history of non-Hodgkin’s lymphoma s/p allogenic bone marrow transplant 10 years prior was diagnosed with metastatic anal cancer. She was unresponsive to surgery and chemoradiation, and thus Nivolumab was initiated. Two months into Nivolumab therapy, her creatinine rose from 1.07 to 1.63mg/dl. Nivolumab was held and she was started on prednisone for presumed AIN. Atypically, she had edema and new onset proteinuria with 12.5 g/g on spot UPCR. Urinalysis was otherwise negative. Workup showed C3 and C4 were low at 76 and 10. Paraproteins, ANA, ASO, HBsAg, HCV ab, ANCA, and cryoglobulin were negative. After four weeks of prednisone, her proteinuria persisted. Kidney biopsy showed subendothelial deposits of C3 and IgM consistent with MPGN and mild interstitial inflammation. No features of TMA were found. Findings were felt due to persistent Nivolumab injury. Nivolumab was held for 3 months while prednisone continued. Her creatinine and proteinuria improved but unfortunately her cancer progressed, and she chose to pass away on hospice. Spot UPCR at that time was 1.1 g/g.
Discussion
This case demonstrates an atypical association of Nivolumab with MPGN. Nephrotic syndrome has been rarely reported with checkpoint inhibitors, though prior cases were minimal change disease and membranous nephropathy. We believe this to be the first case of checkpoint inhibitor associated MPGN, suggesting these agents can lead to a broad spectrum of immune-related kidney disorders
PAS / EM with MPGN and subendothelial deposits of C3 and IgM