Abstract: FR-PO207
AKI and "Pseudo-Pyelonephritis" Caused by Immune Checkpoint Inhibitors
Session Information
- Onconephrology: Clinical and Research Advances - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Stalbow, Daniel, Weill Cornell Medicine, New York, New York, United States
- Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
- Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
- Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction
Immune checkpoint inhibitors (ICPis) have an incidence of renal toxicity that ranges from 1 to 5%. ICPi-associated AKI (ICPi-AKI) presents as asymptomatic rise in serum creatinine. Associated symptoms of dysuria, flank pain, fever and radiologic evidence of renal inflammation are rare.
Case Description
Herein we describe three cases (Table below) of biopsy proven ICPi-AKI presenting with dysuria, flank pain and imaging consistent with genitourinary inflammation (Figure below). All patients were empirically treated with antibiotics for suspected infections though urine cultures were negative. Persistent symptoms and rising creatinine led to kidney biopsy which showed acute interstitial inflammation without significant neutrophil infiltration in all three cases. A course of steroids led to the resolution of symptoms and improvement in serum creatinine.
Discussion
These cases highlight the complexity of ICPi-AKI that is not limited to laboratory and histology abnormalities but includes symptoms and imaging consistent with inflammation of the genitourinary tract. If overlooked, patients will be mistreated for an infection causing symptoms to persist and a delay in initiation of immunosuppression.
Three cases of ICPi-AKI presenting with dysuria and imaging consistent with genitourinary inflammation
| Patient | Cancer | ICPi Type | Baseline Creatinine (mg/dL) | Peak Creatinine at Time of AKI (mg/dL) | Symptoms After Start of ICPi | CT Imaging | Urine Culture | Renal Biopsy Findings | Nadir Creatinine (mg/dL) |
| 57F | Breast Cancer | PD-1 | 0.7 | 1.8 | Dysuria, flank pain, fevers x 1 month | Bilateral perinephric stranding, urothelial thickening, and cystitis | Negative | Active tubulointerstitial nephritis, moderately severe. | 0.9 |
| 62M | Melanoma | PD-1 and CTLA-4 | 1 | 4 | Abdominal pain x 11 days | Bilateral perinephric fat stranding and urothelial thickening | Negative | Acute tubulointerstitial nephritis | 1 |
| 46M | Gastric Cancer | PD-1 | 0.8 | 3.7 | Bilateral flank pain x 7 days | Bilateral perinephric fat stranding and urothelial thickening | Negative | Severe active tubulointerstitial nephritis with granulomatous changes. | 1.1 |