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

• Published in: BMC nephrology 2016-11, Vol.17 (1), p.188-188, Article 188
• Main Authors: Jung, Kyungsuk, Zeng, Xu, Bilusic, Marijo
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - therapy; Aged; Antibodies, Monoclonal - adverse effects; Antineoplastic Agents - adverse effects; Carcinoma, Renal Cell - drug therapy; Care and treatment; Case Report; Complications and side effects; Glomerulonephritis; Glomerulonephritis - chemically induced; Glomerulonephritis - therapy; Health aspects; Humans; Immunotherapy; Kidney Neoplasms - drug therapy; Male; Nephrology; Nivolumab
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-016-0408-2

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. 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. 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.