Abstract: FR-PO276
Membranoproliferative Glomerulonephritis (MPGN) Associated with Atezolizumab
Session Information
- Onconephrology: From AKI to CKD and Everything in Between
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Author
- Parveen, Fnu, Baylor College of Medicine, Houston, Texas, United States
Introduction
Immunotherapy is a revolutionary approach to cancer management, particularly in advanced malignancies that have progressed despite traditional chemotherapy. Atezolizumab is a humanized monoclonal antibody immune checkpoint inhibitor that binds to programmed death ligand 1 (PD-L1) to selectively prevent the interaction between the PD-1 and B7.1 receptors.We present a unique case of a patient with acute kidney injury associated with nephrotic syndrome after starting atezolizumab for metastatic pancreatic carcinoma.
Case Description
64 year old female with a past medical history significant for stage 1A endometrial cancer status post (s/p) total abdominal hysterectomy, biliary obstruction s/p stent for locally advanced unresectable pancreatic duct adenocarcinoma FOLFIRINOX completed chemoradiation. She was enrolled in i LOKON - 001 immunotherapy trial with oncolytic virus + atezolizumab + abraxane + gemcitabine and received 9 cycles.
She was admitted for her complaints of shortness of breath and bilateral pedal edema. Her had hypertensive urgency with anasarca on clinical exam. Labs showed acute kidney injury with urinalysis positive for protein and blood. Further work up revealed nephrotic range proteinuria with UPCR 8 g/g. ANA, complements, Urine electrophoresis were negative. Serum electrophoresis showed IgG kappa monoclonal band. Anti-PLA2R receptor normal. Renal vein doppler was negative for renal vein thrombosis. Renal biopsy showed MPGN with full house pattern, immune complex deposit in subendothelium thought to be from atezolizumab. She was taken off the immunotherapy trial and started on diuretics and steroids with significant improvement in her proteinuria and anasarca.
Discussion
Nephrotic syndrome (NS) in this patient was thought to be related to atezolizumab as secondary work up for MPGN was all negative. NS resolved after stopping atezolizumab and starting steroids which is suggestive of atezolizumab related nephrotoxicity.