Abstract

Letter to Editor

Renal Adverse Reaction Secondary to Check-point Inhibitors in Metastatic Renal Cancer

Marta Guerra Lacambra*, Miguel Angel Gonzalez Martinez, Vanesa García Chumillas and Francisco Gutierrez Tejero

Published: 17 May, 2024 | Volume 8 - Issue 2 | Pages: 076-077

Immune Checkpoint Inhibitors (PCIs,) are monoclonal antibodies directed against immune checkpoint regulatory molecules. These antibodies inhibit T-cell activation and prolong survival in patients with different types of cancer. However, they can produce adverse effects related to the immune response such as renal damage.
We present the clinical case of a 75-year-old man with a personal history of Chronic Kidney Disease (CKD) and metastatic renal cancer with lung, bone, and mediastinal involvement. He started treatment with immunotherapy with Nivolumab-Ipilimumab. Then, after 4 cycles of immunotherapy, the patient was admitted to the Urology Department for an adverse reaction to immunotherapy with the development of nephritis and toxic hepatitis. Despite treatment with methylprednisolone, he evolved poorly, and a palliative approach was finally decided.
The incidence of acute renal failure attributed to PCIs is estimated at 2% - 3%, being grade I-II in most cases. Among the renal complications associated with PCIs, acute interstitial nephritis is the most predominant with an incidence of 80% - 90% of cases. In addition, an increased risk is observed in patients with intermediate or poor risk metastatic renal cancer.
Despite their fundamental role in metastatic renal cancer, we must take into account the potential for renal failure as an adverse effect of PCIs, especially in patients with previous CKD.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001130 Cite this Article Read Full Article PDF

Keywords:

Immune checkpoint regulation; Immunotherapy; Renal failure; Nephritis

References

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  3. Gupta S, Short SAP, Sise ME, Prosek JM, Madhavan SM, Soler MJ, et al. Acute kidney injury in patients treated with immune checkpoint inhibitors. J Immunother Cancer. 2021 Oct;9(10):e003467. doi: 10.1136/jitc-2021-003467. Erratum in: J Immunother Cancer. 2023 Apr;11(4): PMID: 34625513; PMCID: PMC8496384.
  4. García-Carro C, Bolufer M, Bury R, Castañeda Z, Muñoz E, Felip E, Lorente D, Carreras MJ, Gabaldon A, Agraz I, Serón D, Soler MJ. Acute kidney injury as a risk factor for mortality in oncological patients receiving checkpoint inhibitors. Nephrol Dial Transplant. 2022 Apr 25;37(5):887-894. doi: 10.1093/ndt/gfab034. PMID: 33547795.
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