Table 1 Glomerulopathy as a complication of anti-PD-1 immunotherapy in 13 cases
From: PD-1 immunobiology in glomerulonephritis and renal cell carcinoma
Underlying Disease | Age Sex | Disease Treatment | Syndrome | Syndrome Treatment | Result |
|---|---|---|---|---|---|
Metastatic clear cell renal carcinoma [11] | 70 M | 10 months of nivolumab 3 mg/kg every 2 weeks subsequent to pazopanib 600 mg daily | Diffuse tubular injury with vacuoles and immune complex-mediated glomerulonephritis with cellular crescents and necrosis | Methylprednisolone 40 mg intravenously 2x/day that was increased to 3x/day, 1g/day, and tapered | Discharged |
Metastatic squamous cell anal carcinoma [23] | 75 F | 2 months (5 cycles) of 2.4 mg/kg nivolumab monotherapy subsequent to colostomy with combined 5-fluororuacil and mitomycin C with radiation | Membranoproliferative glomerulonephritis | Prednisone 40 mg daily | Deceased |
Papillary renal cell carcinoma type 2 [24] | 62 M | 4 cycles of nivolumab 3 mg/kg every 2 weeks subsequent to a cMET inhibitor (INC280), everolimus pazopanib | Early FSGS, due to nivolumab or as a paraneoplastic sign, an acute tubular necrosis, or a postrenal obstruction | IV pulses of 1000 mg methyl-prednisolone for 3 days, followed by prednisone 60 mg/day and mycophenolate mofetil 750 mg twice daily | Discharged, relapse, deceased |
Metastatic lung adeno-carcinoma [25] | 71 F | Pembrolizumab following completion of carboplatin and pemetrexed treatment | Focally crescentic pauci-immune glomerulonephritis | Pulse glucocorticoids followed by high-dose glucocorticoids | Resolution of proteinuria and hematuria |
Squamous cell carcinoma and the development of infectious enterocolitis [26] | 65 M | Pembrolizumab 200 mg, in six infusions, over 4 months subsequent to radiation and cisplatin | Pauci-immune necrotizing crescentic glomerulonephritis with positive peri-nuclear ANCA and myeloperoxidase (MPO) | Methylprednisolone 1000 mg/day for 3 days, followed by prednisone 60 mg/day tapered to 50 mg/day. The patient also received two doses of 1000 mg rituximab | Decreased proteinuria and hematuria |
Stage IV non-small-cell lung cancer [27] | 67 M | Nivolumab 3 mg/kg every 2 weeks subsequent to bevacizumab combined with pemetrexed plus cisplatin followed by maintenance pemetrexed infusion. Lansoprazole 15 mg/day was also prescribed. | Acute tubulointerstitial nephritis (ATIN) | Lansoprazole was discontinued and administration of 500 mg intravenous methylprednisolone for 3 days followed by 1 mg/kg/day oral prednisolone | Positive drug induced lymphocyte stimulating test (DLST) for lansoprazole and improved kidney function |
Metastatic anal canal non-mutated BRAF melanoma [28] | 76 F | 3 cycles of nivolumab (3 mg/kg) administered 8 weeks after ipilimumab (4 cycles of 3 mg/kg) discontinuation | Nivolumab-induced acute immune interstitial nephritis | Oral prednisolone at a daily dose of 0.5 mg/kg (40 mg) and nivolumab eventually discontinued | Improved kidney function |
Stage IV melanoma BRAF wild type [29] | 68 M | Single dose of pembrolizumab (2 mg/kg) as first-line therapy | Acute renal failure with nephrotic syndrome due to a minimal change disease related to pembrolizumab | Oral prednisolone at 100 mg/day and diuretics administered. Pembrolizumab discontinued. | Renal function restored. Ipilimumab (3 mg/kg) and nivolumab (1 mg/kg) resulted in a confirmed a deep partial response after 3 doses |
Metastatic melanoma and prostate cancer in remission [30] | 64 M | 5 cycles pembrolizumab 2 mg/kg every 3 weeks | Diffuse active tubulointerstitial nephritis with severe acute tubular cell injury | IV methyl-prednisolone 1 g/day for three days followed by oral prednisone 60 mg/day and immunotherapy discontinued | With improved renal function patient resumed treatment with ipilimumab instead of pembrolizumab |
Metastatic acral melanoma [30] | 78 F | 3 cycles of nivolumab 3 mg/kg [omeprazole was also prescribed] | Diffuse active chronic tubulointerstitial nephritis with acute tubular cell injury | IV methyl-prednisolone 1 g/day for 3 days followed by oral prednisone 60 mg daily and immunotherapy discontinued | With improved renal function patient resumed treatment with three cycles of temozolomide |
Stage IIA adeno-carcinoma of the lung [31] | 57 M | 4 cycles of biweekly treatments with nivolumab subsequent to radiotherapy and repeated courses of cisplatin, pemetrexed, and bevacizumab [rabeprazole was also prescribed] | Nivolumab-induced acute tubulointerstitial nephritis with CD163+ M2 macrophage infiltration | Prednisolone (55 mg, daily) treatment was initiated. Nivolumab and rabeprazole were discontinued | Renal function improved |
Recurrent gastric cancer and liver metastases [32] | 68 F | 30 cycles of nivolumab subsequent to S-1 plus cisplatin (first-line), paclitaxel monotherapy (second-line) and irinotecan monotherapy (third-line) | Acute granulomatous tubulointerstitial nephritis associated with PD-L1+ lesions and aggregated CD3+ T cells | Nivolumab was discontinued, and the patient was treated with methylprednisolone 1.0 mg/kg (40 mg) daily | Nivolumab was reinstated up to a total of 41 cycles without kidney dysfunction but the cancer was not responsive |
Hodgkin lymphoma [33] | 40 M | 3 doses of camrelizumab (200 mg every 2 weeks) subsequent to classic chemotherapy | Minimal change disease | Camrelizumab was discontinued and patient was treated with prednisone (1 mg/kg/day) | Renal function improved |