Renal Effects after Pembrolizumab Treatment for Non-small Cell Lung Carcinoma

Intern Med. 2020 Apr 1;59(7):977-981. doi: 10.2169/internalmedicine.3928-19. Epub 2019 Dec 6.

Abstract

Immune checkpoint inhibitors (CPIs), including pembrolizumab, are becoming common oncological treatments. CPIs have been associated with a significant risk of developing immune-related adverse events (irAEs), such as nephritis and interstitial nephritis. However, the occurrence of glomerulonephritis has only rarely been reported. We herein present the case of a 75-year-old woman with non-small cell lung carcinoma (NSCLC) who developed proteinuria and microscopic hematuria during treatment with pembrolizumab. Renal biopsy revealed tubulointerstitial nephritis and IgA nephropathy. Considering that a urinalysis showed no abnormality before treatment, the condition might have been induced by pembrolizumab. In this report, we focus on the correct diagnosis and management of renal irAEs, which remain controversial.

Keywords: IgA nephropathy; acute tubulointerstitial nephritis; immune checkpoint inhibitors (CPI); immune-related adverse events (irAEs); onconephrology; pembrolizumab.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antineoplastic Agents, Immunological / adverse effects*
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / physiopathology
  • Clinical Protocols
  • Female
  • Glomerulonephritis, IGA / chemically induced*
  • Glomerulonephritis, IGA / physiopathology
  • Humans
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / physiopathology
  • Nephritis, Interstitial / chemically induced*
  • Nephritis, Interstitial / physiopathology

Substances

  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • pembrolizumab