Nephrotoxicity of Immune Checkpoint Inhibitors

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CONTROL ID: 2788187. TITLE: Nephrotoxicity of Immune Checkpoint Inhibitors: MD Anderson Cancer Center's Experience. AUTHORS: Umut Selamet1, Ali ...
CONTROL ID: 2788187 TITLE: Nephrotoxicity of Immune Checkpoint Inhibitors: MD Anderson Cancer Center’s Experience 1 2 2 1 1 2 AUTHORS: Umut Selamet , Ali Ziaolhagh , Laila S. Lakhani , Amit Lahoti , Biruh Workeneh , Amanda Tchakarov , 2 1 William F. Glass , Ala Abudayyeh INSTITUTIONS: 1. MD Anderson Cancer Center, Houston, TX, United States. 2. UT Houston, Houston, TX, United States. GROUP OR TEAM (if applicable): BODY-Background: Immune checkpoint (ICP) inhibitors, anti-CTLA-4 (Ipilimumab) and anti-PD-1 (Nivolumab and Pembrolizumab) have revolutionized treatment options for many types of cancers. Adverse events associated with ICP inhibitors are mainly due to uninhibited immune system causing autoimmune diseases. Literature on nephrotoxicity of these novel agents is limited. Acute tubulointerstitial nephritis (ATIN) is the most commonly described kidney injury secondary to ICP inhibitors. Few case reports also identified glomerulonephritis (GN) induced by ICP inhibitors. BODY-Methods: We present 7 cases of biopsy proven nephrotoxicity during treatment with ICP inhibitors. Malignancies asscoiated with the cases were as following: Renal cell carcinoma (n=1), smoldering myeloma (n=2), melanoma (n=1), chondroma (n=1), bladder cancer (n=1) and lung cancer (n=1). Six out of 7 cases showed features of ATIN at kidney biopsy specimens. Several types of GNs were also observed: membranous GN, IgA nephropathy, and pauci immune GN. One patient had AA type amyloidosis. ICP inhibitors discontinued in all cases, and 5 cases were also treated with steroid. Steroid treatment resulted in either partial or full renal recovery in 4 out of 5 cases. Cases are summarized at Tables 1 and 2. BODY-Conclusion: Early recognition of nephrotoxicity, utilization of kidney biopsy and steroid treatment for both ATIN and GN are the hallmarks of management of nephrotoxicities induced by ICP inhibitors.

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