Abstract: FR-PO067
Acute Interstitial Nephritis in the Setting of Ipilimumab and Nivolumab Therapy
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention - 2
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Kaur, Rupinder, Southeast Health, Dothan, Alabama, United States
- Singh, Somesh, Alabama College of Osteopathic Medicine, Dothan, Alabama, United States
- Siddiqui, Nabeel, Southeast Health, Dothan, Alabama, United States
- Shah, Bhoomi, Southeast Health, Dothan, Alabama, United States
- Osunsanya, Olawale M., Southeast Health, Dothan, Alabama, United States
Introduction
Certainly, immune checkpoint inhibitors (ICIs) like Ipilimumab and Nivolumab, have become an important strategy in cancer therapy; however, the incidence of renal complications arising from the widespread use of ICIs may be underestimated. A less-known adverse reaction from checkpoint inhibitors is acute interstitial nephritis (AIN), and there are only a few case reports demonstrating AIN related to checkpoint inhibitors.
Case Description
A 74- year-old-male with a recent diagnosis of squamous cell lung carcinoma, on combination therapy with nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) for almost 2 months, presented to us with nausea, vomiting, and associated generalized weakness. On presentation vitals were unremarkable. Creatinine 5.2 mg/dl(baseline 0.8- 0.9 mg/dL), Urine microscopy revealed >100 white blood cells, 1+ protein and 1+ bacteria, urine protein creatinine ratio 926 mg/g, and urine culture resulted negative. Renal ultrasound was unremarkable for any acute findings. He was started on IV fluids.
On the next day, his creatinine worsened to 5.5mg/dl, and urine output was noted to be decreased. A urine Hansel stain was performed which showed increased eosinophils. Eventually, he started on oral prednisone 60mg PO daily for possible drug-related AIN. A renal biopsy revealed acute tubulointerstitial nephritis. Immunotherapy was discontinued. His creatinine subsequently improved, and he was discharged on 4-week taper of oral prednisone.
Discussion
The significant ICI-induced renal adverse event known as AIN is brought to light in this case, emphasizing the need for careful monitoring of renal function in patients undergoing immunotherapy with these drugs. AIN can occur days to several months after initiation of an offending agent. Although AIN is typically associated with medications such as non-steroidal inflammatory agents, proton pump inhibitors, or antibiotics, checkpoint inhibitors related to AIN have been reported. A brief course of corticosteroid therapy is a viable therapeutic strategy to attain full or partial remission.
The true incidence of renal complications from ICIs is underestimated. Early recognition of this rare nephrotoxic reaction by healthcare providers may be important for the subsequent clinical course and recovery from AKI.