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Abstract：
Immune checkpoint inhibitors (ICIs) became the standard treatment for many different kinds of cancers and can result in a variety of immune-related adverse events (irAEs). IrAEs of kidney are uncommon and consists of different pathology types. Among the different types, membranous nephropathy (MN) is rare and have not been well-described. Since MN can also be associated with malignancies, differential diagnosis in patients receiving ICIs who develop MN can be very difficult. We present the case of a 74-year-old man with metastatic non-small cell lung cancer who developed MN after ICIs therapy. The patient tested positive for thrombospondin type-1 domain-containing 7A antibodies (THSD7A) when diagnosed with MN. Supplementary examinations revealed the predisposing antigen in the primary tumor and present of the antibody after immunotherapy, which corresponded to the patient\'s clinical course of nephropathy. Treatment consisting of systemic glucocorticoids and rituximab resulted in a good clinical response, and the THSD7A antibodies were no longer detected. In this case, we first discuss the potential mechanism of immunotherapy related MN, in which the activation of humoral immunity may play an important role.
摘要：
免疫检查点抑制剂（ICIs）成为许多不同类型癌症的标准治疗方法，并可能导致各种免疫相关不良事件（irAE）。肾脏的IrAE并不常见，由不同的病理类型组成。在不同的类型中，膜性肾病（MN）是罕见的，并没有得到很好的描述。由于MN也可能与恶性肿瘤有关，患有MN的ICIs患者的鉴别诊断可能非常困难。我们介绍了一名74岁的转移性非小细胞肺癌患者，该患者在ICIs治疗后发展为MN。当诊断为MN时，患者的含血小板反应蛋白1型结构域的7A抗体（THSD7A）检测呈阳性。补充检查显示原发性肿瘤中的易感抗原和免疫治疗后的抗体存在，这与患者的肾病临床病程相对应。由全身性糖皮质激素和利妥昔单抗组成的治疗产生了良好的临床反应。并且不再检测到THSD7A抗体。在这种情况下,我们首先讨论了与MN相关的免疫治疗的潜在机制，其中体液免疫的激活可能起重要作用。
