2022 Volume 55 Issue 10 Pages 595-601
A 76-year-old male underwent left nephrectomy for left renal cell carcinoma in July X-3. In July X-2, metastasis to the left crus of the diaphragm was confirmed. He was treated with pazopanib and axitinib, but the disease progressed. He was treated with heavy particle irradiation. However, in February X metastasis was detected in the upper lobe of the right lung, and he was started on nivolumab. Before the start of the nivolumab treatment, he had a serum creatinine level (S-Cr) of 1.52 mg/dL, and urinary tests produced the following results：urinary protein (–) and urinary occult blood (–). He received 240 mg nivolumab every 2 weeks for a total of 4 doses. After that, his S-Cr increased to 3.6 mg/dL. He was referred to our department and admitted in June X. On the 8th day, a renal biopsy was performed. Crescentic glomerulonephritis and acute tubulointerstitial nephritis were diagnosed. Steroid therapy was started on the 12th day. Although he needed hemodialysis for 2 weeks, he achieved a partial renal recovery. As crescentic glomerulonephritis caused by immune checkpoint inhibitors is rare, further case accumulation is needed.
