Abstract: TH-PO122
Acute Interstitial Nephritis After Treatment with the Human Anti-CD20 Antibody Ocrelizumab: First Case Report
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Alhalabi, Hassan, Dallas Nephrology Associates, Irving, Texas, United States
Introduction
Acute interstitial nephritis (AIN) is an important cause of acute kidney injury and is commonly caused by drugs. Ocrelizumab, a humanized anti-CD20 antibody, was recently approved as a treatment for primary progressive and relapsing multiple sclerosis. Here we report a patient who developed severe AIN requiring hemodialysis after receiving Ocrelizumab.
Case Description
A 64-year-old female with a history of diabetes and hypertension received the first infusion of Ocrelizumab 300 mg for multiple sclerosis. One week later she presented to the emergency room complaining of fatigue and generalized weakness. Laboratory findings were significant for a creatinine of 5.5 mg/dL (was 0.9 mg/dL a few days prior). Her creatinine continued to increase to 10 mg/dL on hospital day 4 requiring initiation of hemodialysis. Urinalysis showed moderate blood, +3 protein, 21 RBC’s, 11 WBC’s. Serologic work-up included a normal C3, C4, ANA, ANCA, anti-GBM, and SPEP/UPEP. Renal ultrasound was normal. A kidney biopsy was performed which demonstrated a moderate mixed interstitial infiltrate with many eosinophils, in a background of interstitial edema. The tubules were dilated and showed significant degenerative changes in tubular epithelial cells, with intratubular calcium oxalate crystals and intratubular degenerative debris. No viral inclusions were seen and there was minimal to mild interstitial fibrosis. The patient was started on oral prednisone 60 mg daily with a subsequent slow taper. Renal function significantly improved with the creatinine trending down to 2.4 mg/dL two weeks later on clinic follow-up.
Discussion
Ocrelizumab, a humanized anti-CD20 monoclonal antibody, was recently approved for the treatment of primary progressive and relapsing multiple sclerosis. To our knowledge, this is the first report of severe AIN associated with an anti-CD20 antibody. In this case, the patient responded well to treatment with high dose steroids. Our report highlights the need to monitor patients closely for potential renal toxicities that may be associated with such medications.