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

Rikako Oki; Yosuke Hirakawa; Hitomi Kimura; Kenjiro Honda; Munetoshi Hinata; Hiroyuki Abe; Yukako Domoto; Goh Tanaka; Takahide Nagase; Masaomi Nangaku

doi:10.2169/internalmedicine.3928-19

CASE REPORTS

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

Rikako Oki, Yosuke Hirakawa, Hitomi Kimura, Kenjiro Honda, Munetoshi Hinata, Hiroyuki Abe, Yukako Domoto, Goh Tanaka, Takahide Nagase, Masaomi Nangaku

Author information

Rikako Oki
Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
Yosuke Hirakawa
Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
Hitomi Kimura
Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
Kenjiro Honda
Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
Munetoshi Hinata
Department of Pathology, The University of Tokyo Hospital, Japan
Hiroyuki Abe
Department of Pathology, The University of Tokyo Hospital, Japan
Yukako Domoto
Department of Pathology, The University of Tokyo Hospital, Japan
Goh Tanaka
Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
Takahide Nagase
Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
Masaomi Nangaku
Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan

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

JOURNAL OPEN ACCESS

2020 Volume 59 Issue 7 Pages 977-981

DOI https://doi.org/10.2169/internalmedicine.3928-19

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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.

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