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Nivolumab-associated acute glomerulonephritis: a case report and literature review

View Article: PubMed Central - PubMed

ABSTRACT

Background: Immune checkpoint inhibitors are changing the landscape of oncology treatment as they are significantly improving treatment for multiple malignancies. Nivolumab, an anti-programmed death 1 antibody, is a US Food and Drug Administration-approved treatment for melanoma, non-small cell lung cancer, and kidney cancer but can result in a spectrum of autoimmune side effects. Adverse effects can occur within any organ system in the body including the colon, lung, liver, endocrine systems, or kidneys.

Case presentation: A 70-year-old male with clear cell kidney cancer was admitted with acute kidney injury while on nivolumab. A kidney biopsy revealed diffuse tubular injury and immune complex-mediated glomerulonephritis. Electron microscopy of the specimen showed hump-like subepithelial deposits. Nivolumab was discontinued and the patient was started on a high dose of steroids. After 5 months of systemic corticosteroids and hemodialysis, the patient’s kidney function improved to his baseline level. Despite a prolonged interruption to treatment, immunosuppressive therapy did not compromise the anticancer effects of nivolumab.

Conclusion: Immune-related adverse effects in the kidney can cause autoimmune glomerulonephritis as well as tubulointerstitial injury. In the literature, immune-related nephritis generally responded well to systemic corticosteroid treatment. Based on our experience, a prolonged course of a high dose of steroids and hemodialysis may be required to achieve an adequate treatment effect.

No MeSH data available.


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Microscopic examinations of kidney biopsy specimens. a and b Hematoxylin and eosin staining of the kidney biopsy specimen revealed interstitial infiltrate with tubular injury (arrows), glomerulonephritis with cellular crescents (arrowhead), and mesangial proliferation (arrow). c Immunofluorescence staining for IgA deposits. d Electron microscopic picture of subepithelial deposit (arrow)
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Fig1: Microscopic examinations of kidney biopsy specimens. a and b Hematoxylin and eosin staining of the kidney biopsy specimen revealed interstitial infiltrate with tubular injury (arrows), glomerulonephritis with cellular crescents (arrowhead), and mesangial proliferation (arrow). c Immunofluorescence staining for IgA deposits. d Electron microscopic picture of subepithelial deposit (arrow)

Mentions: Biopsy of the right lower pole of the kidney was performed on October 29, 2014. Light microscopic examination demonstrated diffuse tubular injury with vacuoles and immune complex-mediated glomerulonephritis with cellular crescents and necrosis. There was moderate interstitial inflammation with lymphocytes observed. With immunofluorescence, there was diffuse granular mesangial staining for IgA, C3, and kappa and lambda light chains. The specimen was also sent for electron microscopic examination. One glomerulus with severe cellular crescents was selected for examination and demonstrated several hump-like subepithelial deposits and no subendothelial deposits. There was partial podocyte foot process effacement. Proximal tubules were flattened with simplified tubular epithelium and shorter microvilli. Pathologic examinations confirmed the final diagnosis of acute toxic-type tubular injury and IgA-dominant acute post-infectious glomerulonephritis. Pictures of microscopic examinations are shown in Fig. 1.Fig. 1


Nivolumab-associated acute glomerulonephritis: a case report and literature review
Microscopic examinations of kidney biopsy specimens. a and b Hematoxylin and eosin staining of the kidney biopsy specimen revealed interstitial infiltrate with tubular injury (arrows), glomerulonephritis with cellular crescents (arrowhead), and mesangial proliferation (arrow). c Immunofluorescence staining for IgA deposits. d Electron microscopic picture of subepithelial deposit (arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120473&req=5

Fig1: Microscopic examinations of kidney biopsy specimens. a and b Hematoxylin and eosin staining of the kidney biopsy specimen revealed interstitial infiltrate with tubular injury (arrows), glomerulonephritis with cellular crescents (arrowhead), and mesangial proliferation (arrow). c Immunofluorescence staining for IgA deposits. d Electron microscopic picture of subepithelial deposit (arrow)
Mentions: Biopsy of the right lower pole of the kidney was performed on October 29, 2014. Light microscopic examination demonstrated diffuse tubular injury with vacuoles and immune complex-mediated glomerulonephritis with cellular crescents and necrosis. There was moderate interstitial inflammation with lymphocytes observed. With immunofluorescence, there was diffuse granular mesangial staining for IgA, C3, and kappa and lambda light chains. The specimen was also sent for electron microscopic examination. One glomerulus with severe cellular crescents was selected for examination and demonstrated several hump-like subepithelial deposits and no subendothelial deposits. There was partial podocyte foot process effacement. Proximal tubules were flattened with simplified tubular epithelium and shorter microvilli. Pathologic examinations confirmed the final diagnosis of acute toxic-type tubular injury and IgA-dominant acute post-infectious glomerulonephritis. Pictures of microscopic examinations are shown in Fig. 1.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Immune checkpoint inhibitors are changing the landscape of oncology treatment as they are significantly improving treatment for multiple malignancies. Nivolumab, an anti-programmed death 1 antibody, is a US Food and Drug Administration-approved treatment for melanoma, non-small cell lung cancer, and kidney cancer but can result in a spectrum of autoimmune side effects. Adverse effects can occur within any organ system in the body including the colon, lung, liver, endocrine systems, or kidneys.

Case presentation: A 70-year-old male with clear cell kidney cancer was admitted with acute kidney injury while on nivolumab. A kidney biopsy revealed diffuse tubular injury and immune complex-mediated glomerulonephritis. Electron microscopy of the specimen showed hump-like subepithelial deposits. Nivolumab was discontinued and the patient was started on a high dose of steroids. After 5 months of systemic corticosteroids and hemodialysis, the patient’s kidney function improved to his baseline level. Despite a prolonged interruption to treatment, immunosuppressive therapy did not compromise the anticancer effects of nivolumab.

Conclusion: Immune-related adverse effects in the kidney can cause autoimmune glomerulonephritis as well as tubulointerstitial injury. In the literature, immune-related nephritis generally responded well to systemic corticosteroid treatment. Based on our experience, a prolonged course of a high dose of steroids and hemodialysis may be required to achieve an adequate treatment effect.

No MeSH data available.


Related in: MedlinePlus